Endocrine Abstracts

Background: Primary hypoadrenalism with bilateral adrenal enlargement is a relatively rare condition. We present four such patients. Case 1: 60 year old male presented with malaise, weight loss and hyponatremia. Short synacthen test was abnormal and ACTH was raised (309 ng/L). CT adrenals showed bilateral adrenal enlargement with uniform texture and low attenuation with no change in repeat CT. FNAC of adrenal gland showed infarcts. Further tests confirmed antiphospholipid antibody syndrome. Case 2:69 year old female admitted with sepsis, renal failure and hypotension. Short synacthen test was abnormal and ACTH was raised (100 ng/L). CT adrenals showed bilateral adrenal enlargement suggestive of metastases. Repeat CT however revealed normal appearances. Probable diagnosis was Waterhouse Fredrickson syndrome. Case 3:86 year old male admitted with seizures secondary to hyponatremia. Short synacthen test was abnormal and ACTH was raised (70 ng/L). CT adrenals showed bilateral adrenal enlargement suggestive of metastases. CT done at 4 months interval did not reveal any primary lesion and adrenal masses enlarged by 50%. His clinical condition deteriorated rapidly and he died. Probable diagnosis was malignant disease. Case 4:72 year old female admitted with vomiting, renal failure and diverticulitis. Short synacthen test was abnormal and ACTH was raised (148 ng/L). CT adrenals showed bilateral adrenal enlargement with ill defined margins. On repeat imaging adrenals were normal. In her case we suspect sepsis related adrenal hemorrhage producing this clinical feature Discussion: Bilateral adrenal enlargement with hypoadrenalism is most commonly caused by malignant tumours especially lymphomas followed by tuberculosis and fungal infections. In acute settings especially in hospitalized patients, adrenal hemorrhage or infarction should be considered. Congenital adrenal hyperplasia can also produce this condition.

Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.