Endocrine Abstracts

Introduction: Adrenal-renal fusion is a rare entity wherein the capsule of the adrenal gland is fused to the kidney. Generally asymptomatic, it is only in pathological situations or in cases of adrenal or renal resection that this situation can cause problems. Adrenal transplantation has long been studied in rats solely to treat adrenal insufficiency, but no cases of accidental transplantation have been reported. Here, we report a case of adrenal-renal fusion making intraoperative dissection challenging, followed by a renal transplant including adrenal tissue.

Observation: We consulted a 17 years old and obese patient in the nephrology department at Day 1 post renal transplantation with a history of nephropathy for 1 and a half year undergoing haemodialysis at a rate of 2 sessions per week for chronic interstitial nephritis, c complicated by hypertension He received a renal transplant from his sister, complicated peroperatively by the fortuitous discovery of adrenal adhesion to the renal capsule, adrenal tissue was left on the kidney subsequently grafted to the recipient with anastomosis of the graft to the external iliac artery and external iliac vein. Post-operative follow-up was marked by isolated hyperglycemia at 3 g/dl, followed by normoglycemia at daily follow-up. He was put on immunosuppressive prednisolone in decreasing doses up to 50 mg/d, which he is currently taking.

Discussion: Transplantation of adrenal cells is similar to that of a small malignant tumor. Unless it achieves vascularization it will die or remain very small. It is imperative to use a source of a potent angiogenic factor such as FGF 3T3 secreting cells. Overall, in an intact human body, the accidental transplantation of adrenal tissue without preparation or growth factors seems to be doomed to apoptosis.