Endocrine Abstracts

Increasing use of abdominal imaging has led to an increased detection of incidental adrenal masses. These cases are usually referred to the endocrinologist for further investigations. We present two cases with unusual incidentalomas. Case 1: a 63-year old man presented with acute abdominal pain. He was haemodynamically stable and afebrile. Investigations revealed normal biochemistry, amylase and clotting. White cell count raised, haemoglobin and platelets normal. Chest and abdominal x-rays unremarkable, urine and blood cultures negative. CT scan revealed bilateral adrenal enlargement; chest was normal. MRI scan showed bilateral adrenal masses with no lipid suggestive of primary adrenal malignancy or metastasis. A short synacthen test (SST) was subnormal. Three collections for 24-h urine catecholamines and metanephrines were normal apart from raised noradrenaline on one occasion. Repeat MRI three months later revealed marked reduction of both adrenal lesions consistent with resolving adrenal haematomas. A further scan six months later revealed complete resolution. Repeat SST was normal. Case 2: a 42-year old lady presented with a two-year history of abdominal pain. Past medical history included splenectomy following trauma. Abdominal ultrasound showed an adrenal incidentaloma. CT scan revealed a 3 cm right adrenal mass with no lipid and a small abnormality in the left gland; chest was normal. Radiology report indicated it might represent a pheochromocytoma or metastasis. Urinary catecholamines and metanephrines and dexamethasone suppression test were normal. Repeat CT scan four months later showed no significant change. After a further scan six months later it was concluded that the adrenal masses had identical enhancement and attenuation characteristics to the spleen. The spleen was dysmorphic indicating the adrenal abnormality represented splenosis following her previous trauma.

These two cases illustrate the importance of considering less common causes of adrenal masses when imaging findings and hormones assessment are not classical of an adenoma or malignant tumour.