Endocrine Abstracts

Introduction

Adrenal cyst lesions are uncommon and only a few large series have been reported. The pathogenesis is unclear. Currently, adrenal cystic lesions are categorized into endothelial cysts, pseudocysts, epithelial cysts and parasitic cysts. In most cases they are found incidentally in asymptomatic patients or in patients with non-specific gastrointestinal symptoms. We describe three cases of adrenal cysts.

Case report

Case 1: Female patient, 50-year-old, with essential arterial hypertension. An adrenal mass in the right adrenal gland was diagnosed incidentally after an abdominal ultrasound. The CT scan showed a 55 mm cystic lesion with a partially calcified wall, under 20 HU. The laboratory evaluation suggested a non-functional lesion. The patient was submitted to a laparoscopic adrenalectomy. The pathology examination revealed an adrenal cyst with 60 mm of larger axis, with no recognizable epithelial tissue and with a partially calcified wall. Case 2: A 55-year-old female patient, with a previous history of ovarian teratoma, mammary fibroadenomas and arterial hypertension. A nodular cystic lesion in left adrenal gland was diagnosed incidentally after a renal ultrasound that was requested due to recurrent urinary tract infections. The patient underwent a CT scan that showed a cystic lesion, with low density and homogenous content, with 66 mm of larger axis. The laboratory evaluation suggested a non-functional lesion. The patient was submitted to a laparoscopic left adrenalectomy. The pathological examination showed an epithelial cyst with 70 × 50 × 30 mm. Case 3: 56-year-old female patient, with no relevant personal history. An adrenal lesion with 58 mm larger axis, homogenous, with water density, was diagnosed in a lumbar CT scan requested due to a back pain. The laboratory evaluation suggested a non-functional lesion. The patient underwent a MRI that showed a cystic nodular formation with benign characteristics. After 2 years of tight surveillance the cystic nodule is now smaller in size, with 43 mm of larger axis.

Discussion

Adrenal cysts are rare entities, however, due to a significative increase in the demand of imaging exams, the incidence has grown. The choice of treatment is not always clear. In most cases, when the larger axis is above 4 cm the complete excision may be considered an option. In one of the cases described, the patient underwent tight medical vigilance, with a reduction in the size of the cyst and no signs of malignancy 2 years after the diagnosis.