Endocrine Abstracts

A 22 year old man with no medical history presented to the hospital with weight loss, abdominal pain, fever, drenching night sweats and flank pain. His inflammatory markers were elevated, multiple cultures were sent all of which were negative. A CT pulmonary angiogram was requested for a new oxygen requirement. This revealed multiple bilateral lung nodules, mediastinal lymphadenopathy and a 46mm left sided adrenal gland. A follow up CT reported a 7 cm left adrenal necrotic mass and recommended an MRI. The MRI findings were consistent with a soft tissue mass. He was discussed at adrenal MDT as there were concerns that this may be malignant. Consensus was for an adrenal biopsy as the images and biochemistry were not consistent with an adrenocortical carcinoma (normal metanephrines, androgens, cortisol, renin and aldosterone). Adrenal biopsy was normal however a psoas sample was collected which grew staphylococcus aureus and treated with antibiotics. He was reviewed by the respiratory team and had a bronchoscopy/endobronchial ultrasound/lymph node biopsy which ruled out malignancy and tuberculosis. Of note this gentleman’s HIV and hepatitis serology was negative. The MDT plan was for repeat imaging and to drain this collection, however, on serial imaging the mass decreased in size and eventually resolved. His symptoms have resolved, and he has now returned to work. Adrenal abscesses are uncommon but more frequently found in immunocompromised patients (1,2). Patients present with fever, back pain, weight loss and tachycardia (1,3,4). The most common pathogens are fungal (5). It is important to consider this as a differential in patients presenting with suspicious adrenal masses (often bilateral) with systemic symptoms supporting an underlying infection to prevent unnecessary adrenalectomies as well as to follow up after resolution to investigate for adrenal insufficiency (6). Our case is interesting in that he appeared to have spontaneous resolution.