Endocrine Abstracts

Case report: Adrenal pseudocysts are rare bening lesions that usually mimick solid tumors on imaging. Although they are asymptomatic and often discovered incidentally, distinguishing them from clinically important adrenocortical masses may be problematic before surgery. We report the case of a 50-years-old female who was referred to endocrinology outpatient clinic with a 54×58×50 mm sized mass in the left adrenal gland. Abdominal MRI which was performed because of right flank pain has revealed a Type 3 hepatic hydatid cyst and a lobulated margined adrenal lesion. A differential diagnosis of pheochromocytoma, adrenal carcinoma, and metastatic disease was suspected cause adrenal lesion showed high-signal intensity on the T2-weighted image, and an intense enhancement after contrast. The medical history was unremarkable. The patient was normotensive, no cushing or virilization sign was noted on physical exam. Hormonal work-up indicated a non-functional lesion with a suppression on 1 mg Dexamethasone test, normal aldosterone/renin ratio, and normal levels of urinary metanephrines. DHEAS levels were also in normal range. A significant FDG accumulation was not present at PET-CT imaging. An uneventful laparoscopic surgery was performed based on radiological features of the lesion suggesting a primary adrenocortical malignancy, and a 5 cm mass was excised. Histological examination reported a cyctic cavity with necrotic debris, fibrin and blood costs and a cyst wall with hyalinized fibrous tissue and atrophic adrenal tissue without a clear lining epithelium or endothelium in adrenal gland. A distrofic calcification area was also observed in the lesion. A multidisciplinary team approach is essential for the diagnosis and management of adrenal lesions; surprising results are pleasing especially in those seen really rare as in this case.