Endocrine Abstracts

Introduction: Cystic adrenal lesions (CAL) are a rare diseases representing 5.4–6.0% of all pathological changes affecting adrenal glands. In about one-third of the cases, lesions are detected incidentally; in the remaining two-thirds cysts lesions are symptomatic, which is typically related to their large size or rapid growth. Although CAL are usually benign, since malignancy is reported in up to 7% of all CAL. Management algorithms for CAL vary and are controversial because of the overall rarity of such lesions.

Case report: We describe a case of a 29-year-old man who presented with abdominal pain. The computed tomography of the upper abdomen revealing the presence of a 4-cm simple cyst originating from the left adrenal. All serological and hormonal secretion tests were negative. So the final diagnosis was a simple left adrenal cyst; 8 months later, abdominal ultrasound follow-up revealed adequate cyst shrinkage down to 2.8×6.9 cm. The patient remains symptom free to date.

Discussion: Surgical excision of adrenal cysts is indicated by the presence of symptoms, suspicion of malignancy, or the detection of a functioning adrenal cyst. Cysts may coexist with primary and metastatic adrenal tumours. Malignancy of the cyst is found in 7% of all affected patients. Adrenocortical and adrenomedullar hyperfunction is accompanied by adrenal cysts in ca. 15% of cases. What is more, adrenal cysts accompany approximately 7% of primary and metastatic cancerous processes, and in 0.5% of cases they are of parasitic origin and their clinical management remains controversial. However, surgical intervention is not recommended for asymptomatic patients with incidental cysts, for the fact that the pathological data of our series revealed no malignant cases. Patients after surgical resection should be followed up closely especially in functional cysts and when histopathology showed cystic tumor.