Endocrine Abstracts

JOINT2147

Introduction: The main goals of evaluating an incidentally detected adrenal mass, termed adrenal incidentaloma (AI), are to characterize the lesion as benign or malignant based on imaging characteristics, and to determine its functionality based on hormone secretion. Non-contrast computed tomography(NCCT) scan is the intial investigation of choice. Washout percentages following intravenous contrast administration are useful in certain cases. A comprehensive endocrine assessment is crucial to rule out hormone secretion abnormalities (e.g. Pheochromocytoma, Cushing syndrome, Primary Hyperaldosteronism). Tumours smaller than 4 cm and with non-contrast attenuation values under 10 HU often do not require long-term follow-up. Management is tailored to clinical presentation and associated comorbidities.

Case Details: A 59-year-old male known case of uncontrolled type 2 diabetes and hypertension presented to the emergency department with a diabetic foot ulcer over right great toe, diffuse abdominal pain, and vomiting. After initial stabilization with iv fluids, empirical antibiotics and insulin for glycemic control, he was planned for surgical debridement. CECT Abdomen revealed cholelithiasis and a right adrenal adenoma. Further, during the hospital stay, the patient’s condition deteriorated with sudden shortness of breath, drowsiness, and desaturation, necessitating intubation. Suspecting pulmonary embolism, thromboprophylaxis with IV heparin was initiated, though a CT pulmonary angiogram ruled out embolism. Post-intubation, the patient developed hypotension for which he was placed on inotropes but still maintained low blood pressure. Keeping in mind the clinical profile, an adrenal CT protocol was performed, and it revealed adrenal hemorrhage. Hormonal evaluation confirmed an adrenal crisis. Steroid replacement therapy was started. His condition gradually improved and underwent successful toe amputation.

Conclusion: Although adrenal incidentalomas rarely present as adrenal crisis, critically ill patients—particularly those with infection, sepsis, or septic shock—may develop this life-threatening condition. Prompt clinical recognition and targeted hormonal evaluation are essential for the early diagnosis and treatment of adrenal crisis, which can be a potentially lethal but treatable complication in ICU settings.