ESPE Abstracts

Background: Adrenal incidentalomas(AIs) are adrenal masses discovered occasionally by radiological evaluation in the absence of clinical features of adrenal disease. Clinical evaluation is important in patients with AIs. AIs are bilateral (10–15%); manifest as nonfunctioning cortical adenomas (70–80%), pheochromocytomas (1.1–11%), subclinical Cushing syndrome (5–20%), primary aldosteronism (1–2%), primary adrenocortical carcinomas (<5%) and metastases (2.5%). AIs are relatively rare in children.

Case presentation: MRI of the heart of a 14-year-old girl with cardiac arrhythmias revealed a mass in the right adrenal gland (RAG). Personal and familial medical histories were unremarkable. She had normal growth, completed puberty and had regular menstruations. She had no symptoms apart from arrhythmias which presented in 24-h Holter monitoring as ventricular bigeminy and trigeminy. Blood pressure, biochemical, hematological evaluations were normal. Pituitary gland (PG) hormonal investigation was normal. Normal serum cortisol concentrations were found following a circadian rhythm. Free cortisol and vanillylmandelic acid levels in a 24-h urine collection were normal. Retroperitoneal space MRI revealed a mass (10.5 cm, with solid and cystic parts) in the RAG, which presented an inhomogeneous enhancement after the intravenous administration of the paramagnetic contrast agent; it was in contact without invasion to the inferior vena cava; there were no signs of lymphadenopathy in the upper abdomen. MRI of brain, hypothalamus and PG was normal. Whole-body I-123-metaiodobenzylguanidine scintigraphy scan revealed a normal distribution of the radioiodinated drug in heart, liver and salivary glands, without uptake from the lesion under investigation. Removal of the RAG and the lesion was performed. Pathology revealed an encapsulated nonfunctioning adrenal cortical adenoma without signs of malignancy.

Conclusion: The incidence of AIs increases even in children because of improved imaging and the use for nonspecific symptoms. Incidentalomas should be differentially diagnosed from malignancies. Surgery is indicated for secretory tumors and those with increased dimensions or radiological features for malignancy.