Bilateral adrenal incidentalomas: a case report and review of diagnostic challenges

Abstract

Incidentally discovered adrenal masses (incidentalomas) are common and present challenges both in diagnosis and management. When incidentally discovered adrenal masses are bilateral, a refined diagnostic approach is warranted since bilateral disease is more likely to be pathologic. We review a case of a 34-year-old man with incidentally discovered bilateral adrenal nodules. A comprehensive diagnostic strategy led to the diagnosis of bilateral pheochromocytoma caused by von Hippel-Lindau syndrome. He was successfully treated with bilateral laparoscopic adrenalectomy and has recovered well. While the initial diagnostic approach is similar to the unilateral incidentaloma, additional testing and/or genetic testing should be considered in the case of the bilateral adrenal mass.

Figure 1

T2-weighted MRI of the abdomen showing bilateral adrenal masses. The left mass measures 4.3 cm and the right mass measures 2.8 cm in greatest dimension.

Figure 2

Histologic sections from the right (a) and left (b) show an alveolar (zellballen) architecture with tumor cells surrounded by a delicate fibrous framework. The tumor cells show variable nuclear pleomorphism and contain granular and basophilic to amphophilic cytoplasm. Hemorrhage (a) and hemosiderin (b) are common in these tumors. Both images are at 200x magnification and are stained with hematoxylin and eosin.