Adrenal Lesions Evaluated in A Pediatric Endocrinology Department

Közler Selen Hürmüzlü; Koçer Gizem Böke; Gözde Gürpınar; Esra Koçyiğit; Aygün Sibel Tuğçe; Jeremy Jones; Jones Filiz Çizmecioğlu

Introduction and Aim: Adrenal lesions (AL) in childhood present with a variety of clinical features, and their evaluation can be challenging. Diagnosis and follow-up should be evaluated on a case-by-case basis. Adrenal hemorrhage (AH) can be seen in infants due to sepsis and prematurity. Adrenal incidentalomas (AI) are detected in imaging performed without suspicion of adrenal disease. We aimed to present the characteristics of the cases evaluated for AL.

Materials-Methods: Children who followed-up for AL in 2019&2023 were retrospectively analyzed.

Results: Of the fourteen patients, male (n:5), female (n:9), infants (n:7) and children (n:7). In infants, six were admitted with AH. The median age was 37(3-242) days. The reason for imaging was sepsis(n:4), jaundice (n:1), vomiting(n:1), clitoromegaly (n:1). Median birth week was 38.5; LGA (n:1), AGA(n:6). Physical examination revealed scrotal hyperpigmentation (n:2), normal (n:5). Median AH size was 18,5(12-31)mm. No adrenal insufficiency was detected. The characteristics of the children&adolescents are shown in Table 1. CT taken for high androstenedion on case 2, revealed 10-mm HU: 40.3, washout 75.6% adenoma. A diagnosis of NCCAH was made (PCOS&17 OHP:2.1 ng/mL). Case 3 was diagnosed with hypertension during school-screening. Renal MR-angiography revealed AL. Paraganglioma near the left gland was detected on MRI with elevated plasma normetanephrine (9,5 nmol/L). Adrenal-sparing surgery was performed. Case 4, an AL was seen in USG, MRI showed ganglioneuroma. Adrenalectomy was performed. Case 7 was being followed up for hemihypertrophy, an adrenocortical carcinoma was detected due to cushingoid appearance.

**Table 1.** Features of cases with AL
Patients	1	2	3	4	5	6	7
	Adenoma	Adenoma	Paraganglioma	Ganglioneuroma	Non-adenomatous lesion	Angiomyolipoma	ACC
Age	14	16,6	13,6	16,2	14	15	3,5
Gender	Female	Female	Female	Female	Female	Male	Male
Complaint	Menstrual irregularity	Menstrual irregularity	None	Urinary incontinence	Swelling around eye	Hypertension	weight gain hirsutism
Physical Examination	Obesity	cachexia	hypertension	obesity	normal	hypertension	cushingoid hemihypertrophy
MRI size(mm)	8 Fat-rich-adenoma	8 Fat-rich-adenoma	25 Pheochromocytoma	28*26 Fat-poor-lesion	36*16 Non-adenomatous-lesion	8 Angiomyo lipoma	40*38 Fat-poor-lesion

Discussion & Conclusion: The most common cause of AL was AH in infancy, AI in childhood&adolescence. Sepsis was the only risk factor in term and normal birth weight infants. Monitoring of AH is sufficient unless it causes adrenal insufficiency. There are no guidelines regarding AI in childhood, and imaging is not sufficient to differentiate benign-malignant. Establishing guidelines for pediatric AI through larger studies will guide clinicians and reduce morbidity.

ESPE Abstracts

P2-23