Endocrine Abstracts

Introduction: Adrenal hemangioma (AH) is a benign vascular tumor of the adrenal gland. The adrenal site of an hemangioma is extremely rare occurring only in 0.01% of cases and accounts for 63 reported cases in the literature. AH are often discovered as incidentalomas either by imaging studies or histologic examination. The role of computed tomography (CT) scan and Magnetic resonance imaging (MRI) is important for the differential diagnosis.

Case report: We report a case of a 56-year-old female patient who was referred to the department of endocrinology for exploration of an adrenal incidentaloma. The mass was detected at a CT scan performed to explore chronic back pain. The patient was treated for hypertension for 10 years. Clinically, she was suffering from headache, heart palpitations, sweating. Her blood pressure was high even though she was taking 2 antihypertensive drugs. She did not present any specific skin lesion. Multiple biological exams were performed: 24-h urinary catecholamine, 4 mg dexamethasone test, aldosteronin/renin ratio. The results were all negative. Since the tumor’s radiological characteristic were leading to a malignant lesion, surgical treatment was decided and a right adrenalectomy was performed. The histological results concluded to an adrenal hemangioma. During follow-up, one year after the surgery, the patient continued to have a vague abdominal pain after, for which a CT scan was performed, showing a new mass in the left adrenal gland. The hormonal work-up was normal and the tumor was benign in the last CT scan. As for her family history, her sister was admitted for exploration of bilateral adrenal incidentaloma who turned out to be a benign non secretory adenoma.

Conclusion: The adrenal hemangioma is a rare adrenal gland lesion, benign and usually asymptomatic. Imagery is the best tool to characterize these silent adrenal masses. The main risks of the hemangioma are ignorance of malignancy, abdominal mass syndrome and bleeding. In this situation comes the role of Positron Emission Tomography with 18F-FDG to distinguish the malignant tumors and therefore reassure the proper treatment.