Endocrine Abstracts

Introduction: Hydatid disease (Cystic echinococcosis) is a zoonotic parasitic infection with the Echinococcus granulosus tapeworm resulting in cyst(s) within viscera. The predominant site for cyst formation is the live, with primary adrenal cyst accounting for less than 0.5% of presentation. We report a case of primary adrenal hydatid disease.

Case report: A 62 year old female presented to the hospital with history of right upper quadrant pain and recurrent urinary tract infections. She underwent a CT scan of abdomen that demonstrated a large cystic lesion measuring 14.7cm (CC) x12.4cm (AP) x 11.6cm (W) in the right upper quadrant and contains fluid/fat at the anterior aspect with peripheral calcification. Her bloods showed evidence of hypereosinophilia (2.01 x109/l). She had extensive travel history in the past, including the countries endemic with hydatid cyst. Although Echinococcal IgG assay was negative, she was started on an extensive course of Albendazol on the basis of strong clinical suspicion. Given the primary location of the cyst, she had adrenal screening blood tests which were all within normal range. She underwent open exploration which confirmed right adrenal cyst and therefore had right adrenalectomy and pericystectomy. Histology report confirmed fibrous cavity wall compatible with a Hydatid cyst. She recovered well after the surgery. Interestingly her requirement of blood pressure medication decreased since the operation.

Discussion and learning point: Hydatid cyst of the adrenal gland is an uncommon pathology, which should be suspected in case of any cystic tumor of the adrenal gland. Echinococcal IgG assay is commonly negative in un-ruptured hydatid disease. Differentiation of large primary liver and adrenal peri-diaphragmatic cysts may prove difficult as adrenal function may be normal in adrenal cyst and imaging indeterminate therefore surgical exploration is deemed necessary to determine location. Association between an adrenal hydatid cyst with hypertension is still unclear.