Case Report

The patient was a 72-year-old man who was incidentally discovered to have a 2-cm left adrenal mass on an abdominal computed tomography (CT) scan that was obtained to evaluate abdominal pain ( Fig. 76.1 ). His physician advised follow-up CT scan 6 months later. However, the follow-upabdominal CT scan was not performed until1.5 years later, when the left adrenal mass measured 5.1 × 3.2 × 5.1 cm with an unenhanced CT attenuation of 32.3 Hounsfield units (HU) (see Fig. 76.1 ). He had no paroxysmal symptoms. He did have a 30-year history of hypertension, which was controlled with a four-drug program. Type 2 diabetes mellitus had been diagnosed 6 years previously. His weight had been stable. He had no signs or symptoms of Cushing syndrome. There was no history of hypokalemia. His medications included amlodipine, 10 mg daily; lisinopril, 20 mg daily; metoprolol, 50 mg daily; hydrochlorothiazide, 12.5 mgdaily; and metformin, 850 mg twice daily. On physical examination his body mass index was41.8 kg/m ² , blood pressure 125/72 mmHg, and heart rate 69 beats per minute. He had no stigmata of an adrenal disorder. Heart and lung examinations were normal.

Axial images from enhanced abdominal computed tomography (CT) scans at baseline (A) and 1.5 years later (B). At baseline, the left adrenal mass measured 2.0 cm × 1.3 cm × g 1.9 cm (arrow) , and unenhanced images were not obtained. On the follow-up scan the left adrenal mass measured 5.1 cm × 3.2 cm × 5.1 cm, and the unenhanced CT attenuation was 32.3 Hounsfield units.

INVESTIGATIONS

The laboratory studies were normal ( Table 76.1 ). There was no biochemical evidence of functioning pheochromocytoma, cortisol secretory autonomy, or primary aldosteronism. A F-18 fluorodeoxyglucose (FDG) positron emission tomography scan showed a FDG-avid left adrenal mass and no other areas of abnormal uptake ( Fig. 76.2 ).

TABLE 76.1

Laboratory Tests

Biochemical Test	Result	Reference Range
Sodium, mmol/L Potassium, mmol/L Fasting plasma glucose, mg/dL Creatinine, mg/dL Aldosterone, ng/dL Plasma renin activity ng/mL per hour DHEA-S, mcg/dL 1-mg overnight DST, cortisol mcg/dL Plasma metanephrine, nmol/L Plasma normetanephrine, nmol/L	138 4.4 115 0.9 8.1 6.8 199 <1.0 <0.2 0.56	135–145 3.6–5.2 70–100 0.8–1.3 ≤21 ng/dL ≤0.6–3 25–131 <1.8 <0.5 <0.9

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