Endocrine Abstracts

The prevalence of adrenal incidentaloma on abdominal Computed Tomography (CT) is around 4.4%. This prevalence is increased in obese, diabetic, hypertensive patients, and could be as high as 10% in older patients. Unilateral adrenal masses larger than 4 cm should be considered for surgical removal to avoid missing adrenal carcinoma, particularly in younger patients.

This is the case of a 67 year old gentleman with Type 2 diabetes mellitus, known to have hypertension, hypercholesterolaemia, ischaemic heart disease with six coronary stents, and iron deficiency anaemia. He was on polypharmacy including aspirin, clopidogrel, bisoprolol, amlodipine, oral hypoglycaemic agents, insulin and iron supplementation. He presented with increased urinary frequency and pain in the right flank. Urinalysis and examination of all systems were unremarkable.

An ultrasound of kidney, ureter, and bladder (KUB) was performed showed a well-defined solid echogenic mass superior to the right kidney measuring 98×76×85 mm with no vascularity. CT of the adrenals and abdomen revealed a 7 cm right adrenal mass, most likely myelolipoma, multiple bilateral small renal cysts, and an extensively calcified atherosclerotic abdominal aorta. Phaeochromocytoma and Conn’s syndrome were ruled out following normal 24 hour urinary metanephrines and normal renin aldosterone ratio. It was rather unlikely for Cushing’s in view of normal 24 hour urinary cortisol and lack of the clinical stigmata of excess cortisol.

Conclusion: Is it best to leave it alone, bearing in mind his multiple co morbidities or to operate in view of right flank pain, the size of tumour, and the risk of bleeding in this type of tumour?