Silent Adrenal Mass With Diagnostic Challenge: A Case of Huge Non-Functioning Adrenal Lesion Mimicking Malignancy
https://doi.org/10.15605/jafes.041.S1
- Author:
Sarojini Devi Simanchalam
1
;
Hamizah Hamzah
1
;
Lee Qin Zhi
2
;
Poh Shean Wong
1
;
Chin Voon Tong
2
;
Tiang Koi Ng
3
;
Nor Afidah Karim
1
;
Noor Lita Adam
1
Author Information
1. Unit Endocrinology, Department of Medicine, Hospital Tuanku Jaafar
2. Department of Endocrinology, Institute Endocrine, Hospital Putrajaya
3. Unit Infectious Disease, Department of Medicine, Hospital Tuanku Jaafar
- Publication Type:Journal Article
- MeSH:
Neoplasms
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):24-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Adrenal incidentalomas are increasingly detected with
the widespread use of imaging, whereby the large or
heterogeneous lesions often raise concern for adrenocortical carcinoma (ACC). However, certain rare benign and infectious conditions may closely mimic malignant
features, posing a diagnostic challenge.
Case:A 64-year-old female with diabetes mellitus, hypertension,
and dyslipidemia was noted to have progressively rising
alkaline phosphatase during routine follow-up. She had
non-specific gastrointestinal symptoms. A computed
tomography abdomen pelvis showed a large, lobulated
mass at the left flank, likely of adrenal origin. An adrenal
protocol computed tomography revealed a large,
heterogeneously enhancing left suprarenal mass measuring
10.7 × 10.3 × 10.7 cm, with a plain-phase attenuation of +81
Hounsfield Unit and absolute (28%) and relative (18%)
washout. The right adrenal gland was normal, with no
evidence of distant metastasis.
Hormonal evaluation showed normal 24-hour urinary
metanephrines, excluding pheochromocytoma. The
overnight dexamethasone suppression test demonstrated
cortisol of 89 nmol/L, suggestive of mild autonomous
cortisol secretion, without clinical features of overt
hypercortisolism. DHEA was low (0.371 µmol/L), and
adrenocorticotropic hormone was suppressed (1.26 pg/mL).
Evaluation for primary aldosteronism was not done due
to the absence of resistant hypertension or hypokalemia.
The gonadotropin profile was consistent with postmenopausal status (follicle-stimulating hormone (89 IU/L)
and luteinizing hormone (28.9 IU/L) with low estradiol.
The patient underwent open left adrenalectomy. Histopathology revealed an adrenal cavernous hemangioma
with extensive hemorrhage and infarction, alongside
necrotizing granulomatous inflammation with numerous
intracellular fungal organisms and narrow-based budding
yeast forms, highly suggestive of histoplasmosis, with
no evidence of malignancy. She was subsequently comanaged with infectious disease team and commenced on
intravenous amphotericin B.
Conclusion:This is a rare coexistence of an adrenal hemangioma
and histoplasmosis, presenting as a large adrenal
mass mimicking ACC. The limitations of imaging in
differentiating benign from malignant adrenal lesions
are revealed and emphasize the role of histopathological
confirmation. Increased awareness of such entities can
support the diagnosis and management.
- Full text:2026072813372858938EP_A012.pdf
