Large "Growing" Adrenal Mass with an Unexpected Histology
https://doi.org/10.15605/jafes.041.S1
- Author:
Ling Hui Kiu
1
;
Ee Wen Loh
1
;
Pei Lin Chan
1
;
Florence Hui Sieng Tan
1
Author Information
1. Endocrinology Unit, Department of Medicine, Sarawak General Hospital
- Publication Type:Journal Article
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):24-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Large, rapidly enlarging adrenal masses typically mandate
surgical intervention given the high probability of adrenocortical carcinoma (ACC). However, benign processes can mimic these aggressive growth kinetics, creating a
diagnostic challenge for clinicians.
Case:A 74-year-old male with hypertension, atrial fibrillation on
rivaroxaban, and prostate cancer was referred for evaluation
of a right adrenal incidentaloma detected on computed
tomography imaging performed for prostate cancer
staging. The well-defined mass measured 8.9 × 7.8 × 7.5 cm
(AP × W × CC) with areas of calcification. Mean attenuation
was +40 Hounsfield Unit, with no significant washout.
Biochemical evaluation confirmed a non-functioning
lesion (24-hour urine metanephrines 756 mcg/24 hours
[N 246–753 mcg/24 hours]; serum cortisol 62 nmol/L post
overnight dexamethasone suppression test). The patient was otherwise asymptomatic and declined surgical intervention. Repeat imaging 4 months later demonstrated
interval enlargement of the mass to 9.8 × 8.8 × 10.7 cm. Due
to this rapid growth, which was highly concerning for ACC,
the patient underwent laparoscopic right adrenalectomy.
Histopathological examination unexpectedly revealed
an adrenal hematoma without evidence of an underlying
tumor or malignancy.
This case illustrates the difficulty in differentiating
aggressive cortical tumors from atypical hemorrhagic
events. Larger series on adrenal hemorrhage reported
trauma and procedural complications as the leading causes,
with a median size of 3–4 cm. Idiopathic large adrenal
hematomas presenting as rapidly expanding “pseudotumors” are exceptionally rare, with fewer than 20 cases
reported in which surgical resection was performed due to
high preoperative suspicion of malignancy. Additionally,
adrenal hemorrhage attributed to anticoagulant therapy
often occurs bilaterally. Unilateral lesion, especially when
large, can pose a diagnostic challenge as highlighted in
this case.
Conclusion:In patients on anticoagulation, rapid interval growth of
an adrenal mass does not always equate to malignancy.
Recognizing this mimicry in the era of widespread Direct
Oral Anticoagulant use is essential for refining treatment
decision regarding surgical intervention, as most cases exhibited a self-limiting process with spontaneous resolution.
- Full text:2026072813331906491EP_A011.pdf
