Adrenal mass: Unusual presentation and outcome

Abstract

Aim:Adrenal mass may be functioning or nonfunctioning with varied clinical presentations. This study aimed to report the nature and management of uncommon adrenal mass and to review literature.Materials and Methods:This was an retrospective observational analysis of children with uncommon adrenal mass admitted during 2009–2015. Clinical features, investigations, and management of patients were analyzed.Results:Among six, two each were adolescent and neonate, and one each was young infant and prenatal. Clinical presentation was variable; hypertensive retinopathy,[1] virilization[1] and bleeding diathesis,[1] antenatal suprarenal mass,[1] prenatal adrenal angiolipoma,[1] and spontaneous resolution of Stage III suprarenal mass.[1] Ultrasound and contrast-enhanced computed tomography revealed well-defined, heterogeneous adrenal mass. Size varied from 2 to 15 cm. Urinary metanephrine and serum testosterone were raised in adolescent hypertensive boys and virilized girls, respectively. Laparoscopy-assisted adrenalectomy was done in two and other four were managed conservatively. Histopathology of tumor revealed pheochromocytoma and borderline oncocytoma. Spontaneous resolution of adrenal mass had varied etiology; adrenal hemorrhagic lesion,[1] simple cyst,[1] neuroblastoma.[1] Follow-up varied from 3 months to 2 years. All patients were asymptomatic on last follow-up.Conclusion:Close clinical follow-up, contrast-enhanced tomography, and limited/specific endocrine work-up have definite role in the management of uncommon adrenal mass.

The Clinical Value of Prenatal Ultrasonography in the Differential Diagnosis of Fetal Suprarenal Space-Occupying Lesions

“… 8 Previous studies have identified the accuracy of prenatal ultrasound in diagnosing fetal neuroblastoma as 51–70%, adrenal hematoma as 72–86%, and subphrenic pulmonary sequestration as 64–81%. 4 , 9 In the present study, the findings concerning diagnostic accuracy were consistent with those of previous research, with the accuracy of diagnosis of adrenal cyst and subphrenic pulmonary sequestration reaching as high as 85.7%. This indicates that attention should be paid to the value of prenatal ultrasonography as a diagnostic tool.…”

Haemorrhagic suprarenal pseudocysts: a systematic review of a rare condition from family physicians’ perspective during the COVID-19 global pandemic

“…Management of adrenal or suprarenal cysts is largely by surgical excision to exclude malignancy, as enumerated in an American study, where they reviewed 613 cases, including those they had managed, where they found that only 7% of their cases were malignant or potentially malignant, with only 1 reported malignancy, and concluded that aspiration of the cysts may be done 6 in mind when assessing these patients are benign and malignant lesions like adrenal or suprarenal masses e.g., adenocarcinomas or pheochromocytomas 9 . Other rare lesions identified in case reviews include adrenal angiolipoma as possible differential diagnosis 17 , as well as a mucinous cystic neoplasm 11 , and an unusual prenatal diagnosis of an adrenal cyst in pregnancy which had to be excised at laparotomy while the pregnancy was carried to term delivery 12,13,16 . Possibility of the diagnosis of congenital adrenal teratomas should also be borne in mind when examining neonates 14 , as well as a congenital adrenal cystic neuroblastoma 16 .…”

“…When they do, they are often non-specific symptoms, for example respiratory symptoms as highlighted in our case study 4 , left testicular discomfort as identified by a case report in the United Kingdom 8 and epigastric pain and abdominal distension 15 . An Indian case report even reported unusual presentations of hypertensive retinopathy, virilization and bleeding diathesis 17 .…”