Adrenal Schwannoma

Adrenal schwannoma is a rare benign tumor with microscopic features of nerve sheath differentiation. Fewer than 100 cases have been reported in the literature. Herein we share a case of a patient with an adrenal schwannoma who presented with acute tumor infarction.

Case Report

The patient was a 77-year-old man who was well until 10 days before our evaluation when he had abrupt onset of nausea, vomiting, and back pain (7/10 in severity). He went to the emergency department, and a computed tomography (CT) scan of the abdomen disclosed a 9.7 cm × 10 cm × 10.6–cm right adrenal mass ( Fig. 66.1 ). He was informed that he had “cancer” and was given intramuscular pain medicine and oral pain medications and sent home. The back pain slowly resolved over 5 days. He had no paroxysmal symptoms, and there was no history of hypertension. His weight had been stable. He had no signs or symptoms of Cushing syndrome. There was no history of hypokalemia. He had no prior abdominal cross-sectional computed imaging studies. His regular medications included aspirin 81 mg daily and calcium carbonate 600 mg daily. On physical examination his body mass index was 28.2 kg/m ² , blood pressure 126/60 mmHg, and heart rate 68 beats per minute. He had no stigmata of an adrenal disorder. Heart and lung examinations were normal.

INVESTIGATIONS

The laboratory studies were normal ( Table 66.1 ). There was no biochemical evidence for functioning pheochromocytoma or adrenocortical carcinoma.

TABLE 66.1

Laboratory Tests

Biochemical Test	Result	Reference Range
Sodium, mmol/L Potassium, mmol/L Fasting plasma glucose, mg/dL Creatinine, mg/dL 8 am serum cortisol, mcg/dL 8 am serum ACTH, pg/mL DHEA-S, mcg/dL Plasma metanephrine, nmol/L Plasma normetanephrine, nmol/L Plasma aldosterone, ng/dL Plasma renin activity, ng/mL per hour 24-Hour urine: Metanephrine, mcg Normetanephrine, mcg Norepinephrine, mcg Epinephrine, mcg Dopamine, mcg Cortisol, mcg	139 4.2 84 0.8 18 41 81.4 <0.2 0.47 <4.0 2.2 148 523 47 5.5 301 51	135–145 3.6–5.2 70–100 0.6–1.1 7–25 10–60 25–131 <0.5 <0.9 ≤21 ≤0.6–3.0 <400 <900 <80 <20 <400 3.5–45