Endocrine Abstracts

Introduction: Percutaneous ablation has been used over the years for the minimally invasive treatment of liver, kidney, thyroid and, although less frequent, adrenal cysts. We describe the case of a young patient with a large adrenal cyst treated with ethanol ablation, avoiding adrenalectomy.

Clinical case: We present a 32-year-old woman who is referred to Endocrinology due to a 10 cm adrenal incidental finding in an MRI performed due to disc herniation. As her personal history, she presented gestational Diabetes (DM) in both her pregnancies with subsequent type 2 DM and hypertension. Her treatment includes Metformin and Enalapril. She does not have a Cushingoid phenotype. She reports mild abdominal discomfort, occasional headaches and palpitations. Her blood analysis show HbA1c 6.1% with fasting glucose of 153 mg/dl, with metanephrines, Nugent test and urinary free cortisol in the normal range. The CT scan reveals a thin-walled cystic image of 10 cm in diameter, with no apparent interior content and with a probable diagnosis of a right adrenal cyst. After discussing the case in the endocrine tumor committee, we present the patient with the two available alternatives: adrenalectomy or percutaneous ablation with ethanol. After explaining both options to the patient, she chooses sclerosis because it is less aggressive. Under local anaesthesia, 500 ml of yellow liquid are evacuated with the subsequent introduction of 100 ml of ethanol. After 1 hour, another 100 ml of fluid are evacuated to sclerosize the lesion. Upon examination, no adrenal cells are identified in the sample. The patient is discharged the same day. One month after the ablation, the patient undergoes a control ultrasound where a 90% reduction in cyst volume is observed. In another control at 4 months the cyst remains stable in size.

Discussion: Adrenal cysts are rare lesions which may sometimes reach a considerable size. They may result in complications such as infection, haemorrhage, rupture or compression of adjacent structures. Percutaneous ethanol ablation may be a valid alternative to adrenalectomy in patients with large or recurrent cysts.