%0 Journal Article
%T Bilateral Adrenal Incidentalomas: A Case Report and Review of Diagnostic Challenges
%A Anders L. Carlson
%A Annis M. Marney
%A Scott R. Anderson
%A Matthew P. Gilbert
%J Case Reports in Endocrinology
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/953052
%X 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. 1. Introduction The incidentally found adrenal mass presents several complex management issues. Defined as a mass 1£¿cm or more in diameter found during a radiologic study done for reasons other than evaluation for adrenal disease, the adrenal ¡°incidentaloma¡± is present in approximately 6% of the population [1]. The prevalence increases with age, with patients greater than 70 years old having a prevalence of 7%, compared to 0.2% for those age 20¨C29 [2]. Most are nonfunctional benign adenomas, and recently published guidelines address the optimal approach to these lesions [3]. However, the discovery of incidental bilateral adrenal masses requires special attention and an expanded diagnostic approach. 2. Case Presentation The patient is a 34-year-old, Caucasian male who was referred to our endocrinology clinic for evaluation of resistant hypertension. The patient had been experiencing chronic headaches and intermittent episodes of chest pressure for approximately 6 months. He denied other associated symptoms including flushing, diaphoresis, and palpitations. There was no family history of endocrine neoplasms or early cerebral or cardiovascular disease. We obtained a renal artery duplex to evaluate for renovascular disease due to patient¡¯s young age and hypertension. The duplex demonstrated bilateral enlargement of the adrenal glands, and MRI of the abdomen showed high T2 intensity of bilateral adrenal masses with the right-sided mass measuring 4.3£¿cm and the left-sided mass measuring 2.8£¿cm (Figure 1). A 24-hour urine collection demonstrated a normetanephrine level of 9250£¿ug/24 hours (normal range 50¨C650£¿ug/24 hours). Plasma norepinephrine was also elevated at 3127£¿pg/mL (normal supine range 70¨C750£¿pg/mL) with a plasma normetanephrine of 23.1£¿nmol/L (normal < 0.90£¿nmol/L). Early morning
%U http://www.hindawi.com/journals/crie/2013/953052/