Endocrine Abstracts

Adrenal Leiomyomas are very rare tumours. 20 cases have been reported to date. Their management remains difficult and challenging. They tend to present with flank or abdominal pain and have very little biochemical activity, if any.

Case presentation: We present a case of a young 44 year old female. She was referred to Endocrinology services with a history of 2 weeks abdominal pain. She underwent an ultrasound organised in primary care which was suspicious for left upper quadrant mass. Except left sided abdominal pain and palpable mass, she looked well with normal blood pressure and no features of Cushings. CT abdomen identified a large left sided supra-renal mass (17 cm) in close association to the kidney. An Overnight dexamethasone suppression test, plasma metanephrines, aldosterone renin ratio as well as her urine steroid profile was normal. Tumour markers were not elevated. She was referred to adrenal MDT. The working diagnosis was of Adrenal carcinoma. She underwent radical left adrenalectomy and nephrectomy. Histopathology was consistent with a diagnosis of leiomyoma.

Clinical discussion: Adrenal leiomyomas are rare tumours of the adrenal gland. They originate from the smooth muscles of adrenal vein. On imaging these tumours have a heterogeneous pattern making it difficult to ascertain the nature of the mass. Literature search provides evidence supporting biochemical activity in these tumours. Such as “slight elevation of epinephrine and norepinephrine in left adrenal and left renal vein" Another example is elevated blood metaneprines.

Conclusion: Not all adrenal masses are malignant. Non-functioning large masses are almost always considered to be sinister until proven otherwise. Adrenal leomyomas are rare, non-functional, benign tumours needing no further imaging after removal. Adrenal biopsy carries the risk of tumour seeding. The question remains if tumour biopsy would change surgical management in case of benign tumours but does the risk outweigh the benefit.