Disappearing adrenal masses

Abstract

Adrenal incidentalomas are a common finding due to the increasing use and improved technology of imaging studies. The majority of these enlargements are non-functional and irreversible. Publications on reversible adrenal enlargement are sparse. Our patient, a 66-year-old man, was admitted to the hospital due to abdominal discomfort. He was treated for rectal carcinoma 3 years before, and was now free of disease. Computed tomography (CT) scan showed no abnormalities other than the incidental finding of bilateral adrenal enlargement. Metastasis was suspected. The CEA-level, however, was within normal range and there was no evidence of hormonal overproduction. After 1 month the patient was reviewed. Physical examination and laboratory testing were normal. Surprisingly, the CT-scan showed a decreased size of both adrenals and after 3 months even showed completely normalized adrenals. Reversible adrenal enlargements are rare. Commonly described causes of adrenal enlargement are haematomas, cystic lesions and infections of the adrenal glands. The patient in this case did not show any clinical, laboratory or radiological signs of any of these diagnoses. The current existing differential diagnosis for bilateral adrenal enlargement is not sufficient to explain the findings in our patient.

Stress-induced severe transient hypercortisolism with reversible bilateral adrenal enlargement after cardiogenic shock

“…A retrospective study evaluating abdominal CT scans in patients with depression demonstrated that 12 out of 38 subjects had significantly increased adrenal volumes compared to normal controls (6). Nonfunctional reversible adrenal enlargement cases have been previously reported (7,8), suggesting hematomas, cystic lesions, and infections of adrenal glands as possible etiologies. Functional differentials include Cushing's disease with cyclical ACTH production, stress-induced ACTH-dependent adrenal hyperplasia, and ectopic ACTH production.…”

Spontaneously reversible adrenal nodules in primary diffuse large B-cell testicular lymphoma mimicking an extranodal involvement: A case report

“…Furthermore, in the resolution phase of the hypertrophy, the adrenal morphology, in our clinical case, was not typical for post-haemorrhagic evolution, as it showed neither cystic nor calcific involution [16] . Finally, bilateral cystic lesions are rare finding, which can be excluded due to the CT densitometry not compatible with fluid lesions [9] .…”

“…In a study conducted on rats, prolonged depressive-anxious stress induces the activation of the paraventricular hypothalamic nucleus, located at the apex of the HPA axis, resulting in bilateral adrenal hyperplasia downstream [20] . In literature, there are no data on acute stress as a cause for transient adrenal growth even though it is described a clinical case of bilateral adrenal incidentalomas (without hormonal overproduction) disappearing completely and spontaneously after 3 months [9] . The patient described was affected by ileus, developed erysipelas of the right foot with fever and chills during hospitalization.…”

“…body and limbs), which histologically corresponds to an increase in cell size, or in the number of cells in case of hyperplasia [8] . Unlike unilateral adrenal incidentalomas, which concern 4% of CT exams performed [9] , the incidental finding of bilateral adrenal hypertrophy is infrequent, and the literature on such finding is lacking. Our report concerns the history of a patient with primary testicular diffuse large B-cell lymphoma with the appearance of macronodular enlargement of the adrenals in a staging CT survey, with the resulting initial diagnostic hypothesis of a secondary localization of the disease.…”