Endocrine Abstracts

Introduction: Cavernous hemangiomas (CH) are benign vascular tumors that frequently involve the skin, central nervous system or liver. Rarely, they can also affect adrenal glands. Adrenal cavernous hemangiomas are mostly unilateral lesions, typically discovered incidentally on radiological imaging. They generally present in the sixth to seventh decade of life and tend to be asymptomatic and non-functioning tumors. Preoperative differential diagnosis from malignant neoplasms owing to imaging features remains challenging.

Case report: A 58-year-old woman was referred for the evaluation of a left adrenal mass incidentally discovered during an ultrasound conducted for the assessment of acute ureteric colic. The patient was asymptomatic, with no reported headache, palpitations or diaphoresis. Physical examination was unremarkable. A contrast enhanced CT scan of the abdomen revealed a solid exophytic left adrenal mass that measured 4 x 3.5 cm and exhibited heterogeneous contrast enhancement. Imaging characteristics were suggestive of adrenal adenoma with hemorrhagic degeneration. Subsequently, an abdominal magnetic resonance imaging (MIR) was performed, revealing non-specific features. Tumor functionality was explored through a series of laboratory investigations. Analysis revealed an increase in dopamine and noradrenaline levels in a 24-hour urine sample on a single occasion, which was not confirmed in subsequent assessments. No abnormal hormone levels were detected in blood tests. 123I-Metaiodobenzylguanidine (123I-MIBG) scintigraphy showed absence of radiotracer uptake in the adrenal gland. Given the non-specific radiological findings and the exclusion of functionality, it was decided to monitor the lesion, which remained stable in successive radiological follow-ups. In the latest TC scan, performed 6 years after the initial diagnosis, the adrenal mass exhibited an increase in dimensions to 5 x 5.4 cm. Imaging characteristics were suspicious for adrenal myelolipoma as the tumor displayed macroscopic fat. Additionally, a newly appeared 5 mm focal calcification was observed. Due to diagnostic uncertainty and the observed growth, the patient was offered resection, and a retroperitoneal laparoscopic adrenalectomy was performed. The histopathological examination revealed a benign adrenal cavernous hemangioma with extensive thrombosis. The patient recovered without surgical related complications.

Conclusion: Cavernous adrenal hemangiomas are rare tumors that should be considered in the differential diagnosis for nonfunctioning adrenal incidentalomas. They are radiologically heterogeneous, often presenting as hypodense lesions with variable calcification, macroscopic fat or necrosis. These findings can be common to other adrenal lesions such as angiomyolipoma, pheochromocytoma or adrenal carcinoma. Thus, surgical resection is often required to exclude malignancy and the final diagnosis is largely established after histopathological analysis.