Endocrine Abstracts

Primary adrenal cysts are a relatively rare form of lesions with incidence of 0.06% in general population and higher prevalence in women (female-to-male ratio 2.3:1). Adrenal endothelial cysts are the most common form of adrenal cysts subtypes (45%) and they usually present with abdominal or flank pain, or nonspecific symptoms . Adrenocortical carcinomas are a rare condition as well, with an incidence of 1–2 per million per year. The typical clinical presentation may include symptoms of glucocorticoid excess and systemic symptoms such as weight loss, anorexia, leukocytosis, and fever.

We describe a case of a 51-year-old female with poorly controlled hypothyroidism. She presented to endocrinology clinic with a history of fever for three months. The clinical evaluation of fever of unknown origin was unremarkable. A CT scan demonstrated a 3.6 × 2.6 cm heterogenic mass in the leftadrenal. Endocrine blood tests revealed no abnormalities besides overnight dexamethasone (1 mg) suppression test that demonstrated partial suppression of cortisol levels (126 nmol/l). As malignancy was suspected, the patient was referred to surgery and the adrenal was removed laparoscopically. Surprisingly, histology confirmed endothelial/vascular cyst. During multiple follow-up visits over a period of 18 months, the fever has completely resolved. This demonstrates the first known case of endothelial/vascular adrenal cyst presenting with persistent fever.