Endocrine Abstracts

A 49-year-old man who has diabetes mellitus and alcoholic cirrhosis presented to the emergency department due to left upper quadrant abdominal pain and left back soreness for three days. He received sclerotherapy and endoscopic band ligation twice for gastric varices few months prior to admission. On physical examination, he had rebound tenderness at left upper abdomen. The computed tomography (CT) of abdomen revealed diffusely enlarged left adrenal gland with rim-enhanced multi-cystic components and necrosis in pararenal space. One of the two peripheral blood culture yielded streptococcus constellatus. The adrenal hormones were all within normal limits. CT-guided biopsy of the left adrenal gland was performed. The pathology revealed only necrosis with reactive change, and the results of special stains and culture were both negative. The symptoms were resolved after intravenous broad-spectrum antibiotic agents and he continued 6-month course of oral cefixime at outpatient department. During the antibiotic treatment, the Gallium scan showed grossly normal and no definite gallium accumulation at the suprarenal/perirenal soft tissue. The follow-up CT scan showed partial resolution of infiltrative left adrenal lesion after 2-month treatment, and smaller size of left adrenal lesion after 5-month treatment. However, fever with chills and abdominal fullness developed three months after discontinuation of the antibiotic treatment. The CT scan showed enlargement of left adrenal lesion, and recurrent infection or inflammation was suspected. Antibiotic treatment was given again. The peripheral blood culture revealed negative finding. He received CT-guided drainage, and 5 ml yellowish pus was drained. The culture from CT-guided aspiration this time yielded streptococcus constellatus. The patient then received laparoscopic left adrenalectomy, and the pathology revealed chronic inflammation. He was totally recovered uneventfully and no adrenal insufficiency developed during follow-up. Adrenal infection is a rare cause of adrenal disorder in adults. The adrenal gland can be infected by a myriad of pathogens, and Mycobacterium tuberculosis was the most common causative agent. Streptococcus constellatus infection was likely cause abscess, but no report as adrenal abscess. Immunocompromised individuals are at greatest risk for adrenal infection. Antibiotic treatment or surgical intervention remains debate.