Endocrine Abstracts

Background: Management of large indeterminate adrenal masses detected during pregnancy is challenging due to the risk of malignancy and the obstetric risks of surgical intervention. The spectrum of endocrine-related complications of Covid-19 is expanding. We present a case that highlights the challenging management of a large adrenal mass during pregnancy and draws attention to a rare complication of Covid-19.

Case description: 26 yr-old lady presented with Covid-19 pneumonia. CTPA showed an incidental 12.6 cm heterogeneous left adrenal mass. Unenhanced CT showed Hounsfield Units 21. Upon referral in November 2020, she was 7-weeks pregnant without clinical features of glucocorticoid or androgen excess. Adrenal androgens, 24hr urinary free cortisol, and plasma metanephrines were normal. The likelihood of malignancy and the obstetric risks of surgery were discussed with the patient. MRI scan performed 3 months after the initial scan showed no loss of signal on chemical shift but size reduction to 7.9 cm, arguing against malignancy. The 24hr urine steroid metabolome pattern also did not suggest adrenocortical carcinoma. Doppler ultrasound showed a non-vascular, well-defined round 7 cm lesion consistent with adrenal haematoma. The patient had spontaneous miscarriage at 12 weeks. Our Adrenal MDT continued radiological surveillance and MRI scan 3 months later showed further size reduction to 5.5 cm. In June 2021, she was again pregnant. Repeated Doppler ultrasound at 5-weeks’ gestation showed stable adrenal mass, suspicious for the presence of an underlying adrenal tumour. Given the patient’s young age, the Adrenal MDT decided to continue radiological monitoring after delivery.

Conclusion: Unilateral adrenal haemorrhage has very rarely been reported following Covid-19. With history of recent Covid-19, adrenal haematoma should be considered in the differential diagnosis of large heterogeneous adrenal masses. Herein, management was further complicated by pregnancy. Inappropriate adrenal surgery was avoided, hence an experienced multidisciplinary approach is important in complex cases for best clinical outcome.