Bilateral adrenal masses: a single-centre experience

Abstract

BackgroundBilateral adrenal masses may have aetiologies like hyperplasia and infiltrative lesions, besides tumours. Hyperplastic and infiltrative lesions may have coexisting hypocortisolism. Bilateral tumours are likely to have hereditary/syndromic associations. The data on clinical profile of bilateral adrenal masses are limited.AimsTo analyse clinical, biochemical and radiological features, and management outcomes in patients with bilateral adrenal masses.MethodsRetrospective analysis of 70 patients with bilateral adrenal masses presenting to a single tertiary care endocrine centre from western India (2002–2015).ResultsThe most common aetiology was pheochromocytoma (40%), followed by tuberculosis (27.1%), primary adrenal lymphoma (PAL) (10%), metastases (5.7%), non-functioning adenomas (4.3%), primary bilateral macronodular adrenal hyperplasia (4.3%), and others (8.6%). Age at presentation was less in patients with pheochromocytoma (33 years) and tuberculosis (41 years) compared with PAL (48 years) and metastases (61 years) (P<0.001). The presenting symptoms for pheochromocytoma were hyperadrenergic spells (54%) and abdominal pain (29%), whereas tuberculosis presented with adrenal insufficiency (AI) (95%). The presenting symptoms for PAL were AI (57%) and abdominal pain (43%), whereas all cases of metastasis had abdominal pain. Mean size of adrenal masses was the largest in lymphoma (5.5cm) followed by pheochromocytoma (4.8cm), metastasis (4cm) and tuberculosis (2.1cm) (P<0.001). Biochemically, most patients with pheochromocytoma (92.8%) had catecholamine excess. Hypocortisolism was common in tuberculosis (100%) and PAL (71.4%) and absent with metastases (P<0.001).ConclusionIn evaluation of bilateral adrenal masses, age at presentation, presenting symptoms, lesion size, and biochemical features are helpful in delineating varied underlying aetiologies.

Results of Percutaneous Computed Tomography-Guided Biopsy of Adrenal Lesions and Spectrum of Computed Tomography Findings

“…Common causes of bilateral adrenal masses, especially in the setting of adrenal insufficiency, are tuberculosis, histoplasmosis, and lymphoma. [3,4] In addition to these diseases, we have also observed adrenal insufficiency in a case of adrenal metastasis where both adrenals were affected. CT finding of AH has been reported in many studies.…”

Bilateral Adrenal Metastasis Presenting as Adrenal Insufficiency.

“…For adrenal insufficiency to occur 90% of adrenals must be destroyed. In some of the cases adrenal insu-fficiency was found to the presenting manifestation of occult malignancy 3 .Our case presented exactly in the same manner and the first presentation was incidental bilateral adrenal mass (Figure3) which later on found to be having associated primary adrenal insufficiency.Most common primary site from which adrenal metastasis occur is Lungs as shown in various studies 4,5,6 .…”

“…Redman et al reported 33% of their patients with bilateral adrenal metastasis to be having adrenal insufficiency⁴. Lomte et al in their retrospective analysis of 70 patients with bilateral adrenal masses from western India could not find any of their metastatic cases to be associated with primary adrenal insuffi -ciency.Hypocortisolism was more common in tuberculosis in their series.They advise while evaluating for bilateral adrenal masses age at presentation,presenting symptoms,lesion size,and biochemical features to be helpful in delineating varied underlying aetiologies 6 . Other sites from where metastasis to adrenals can occur are colon,stomach,ovaries,and advanced papillary thyroid cancer 5,7,8 .…”

Infectious causes of Addison’s disease: 1 organ—2 organisms!

“…Adrenal glands preserve their contour in 50% of cases 8. In a retrospective study on causes of bilateral enlargement of adrenals from India, tuberculosis was found to be accounting for 27% of cases and was the most common infective cause 9. A definitive diagnosis can only be made by histopathology, either on fine-needle aspiration (FNA) or image-guided biopsy.…”