Endocrine Abstracts

Introduction: Incidentally discovered adrenal masses (incidentalomas) are common and in some cases differential diagnosis could be a challenge.

Case report: A 55-years old woman presented with an incidental left adrenal mass of 36mm discovered on an abdominal ultrasound. As sole background she underwent resective surgery of an ovarian serous cyst. She denied symptoms like flushing, headache, diaphoresis or palpitations. Physical examination was irrelevant. BP: 130/76 mmHg; CF:78 bpm.

Fractionated metanephrines and catecholamines in a 24-hour urine specimen, sodium and potassium levels, 24-hour urinary free cortisol, adrenocorticotropic hormone, aldosterone/plasma renin plasma ratio and dehydroepiandrosterone sulfate were normal.

Abdominal computed tomography showed an heterogeneous left adrenal gland and multiple nodes in locations such as subdiaphragmatic region, celiac trunk, gastrohepatic ligament, splenic hilum and retroperitoneal area, most of them with the presence of central necrosis.

Additionally axillary and paratracheal nodes were found, and also lungs nodules less than 5mm in diameter were described. PET F-18 FDG scan identified an hypodense centrum area suggestive of necrosis into the left adrenal. A tomography guided biopsy only detected necrotic cells. Finally a left adrenalectomy was performed and histopathological study revealed a diffuse large B-Cell non-Hodgkin’s lymphoma. The patient was started on chemotherapy with a successful response.

Conclusion: Biopsy could be necessary in the differential diagnosis of necrotic adrenal masses even when lymph nodes are present.