Bilaterally enlarged adrenal glands without obvious cause: need for a multidisciplinary diagnostic work-up

Abstract

Bilateral enlarged adrenal glands are rare, and as diagnostic delay may have serious consequences for the patient, we recommend a multidisciplinary approach of specialists in the field of endocrinology, oncology, radiology, and clinical chemistry prior to the start of the diagnostic work-up.

Keywords: Adrenal glands; bilateral; diagnostic delay; multidisciplinary.

Figure 1

PET scan of patient 1 showing bilateral enlarged adrenal glands (left 7.5 × 6.4 × 4.6 cm, right 8.1 × 5.8 × 3.9 cm) with highfludeoxyglucose uptake.

Figure 2

CT scan of patient 2 showing bilateral homogeneous enlarged adrenal glands (left 3.2 × 4.5 cm, right 3.5 × 3.9 cm) and two hepatic cysts.

Figure 3

CT scan of patient 3 showing metastatic disease with multiple hepatic lesions, enlargement of both adrenal glands (left 15.3 × 10.0 × 15.6 cm (arrow), right approximately 5 cm; a), and a Bosniak 2F lesion in the right kidney (arrow b). Bosniak 2F lesions are generally benign, with a malignancy rate of 3–12% 25, 26.