Endocrine Abstracts

Introduction: Adrenal medullary hyperplasia (AMH) is a rare syndrome of catecholamine excess. Adrenal overgrowth is usually bilateral. Due to similar clinical signs, laboratory results and radiological adrenal picture, AMH can be misdiagnosed as pheochromocytoma. The only method that allows determining a proper diagnosis of AMH is pathologic examination. It is regarded as a precursor of pheochromocytoma and has been reported as a component of MEN2.

Aim: The aim of the study was to present a patient with AMH primary diagnosed as adrenal incydentaloma.

Case report: 54-year-old female, without hypertension or other symptoms of catecholamine excess, was admitted to our ward because of incidentally discovered nodular masses [18×8 mm] in right adrenal gland. Initial tumor CT density was 36 HU and after contrast administration it was in subsequent phases: 56, 78 and 55 HU respectively. Left adrenal gland was normal. Oncologic vigilance was suggested. Laboratory assessment excluded hormonal activity of the tumor and daily urinary excretion of metoxycatecholamines was 675 μg (n<1000). After the patient was prepared for surgery using doxazosine, laparoscopic left adrenalectomy has been conducted. A postoperative pathologic exploration revealed solid orange-yellowish 8 mm tumor. Microscopic evaluation confirmed nodular adrenal medullary hyperplasia, chromogranine (+), synaptofizyne (+). Because of the risk of developing a tumor in the opposite adrenal gland further observation was recommended.

Conclusion: AMH can develop without clinical symptoms of catecholamine excess and be recognized as adrenal incydentaloma.