We describe three cases of bilateral adrenal masses with different aetiologies. Their clinical details are provided in table 1.
The differential diagnosis of bilateral adrenal masses1 include infective aetiologies such as tuberculosis and histoplasmosis2; infiltrative disorders such as metastasis from an unknown primary, non-Hodgkin’s lymphoma3; amyloidosis and neoplasias such as bilateral pheochromocytoma and adrenocortical carcinoma. Rarely, longstanding untreated congenital adrenal hyperplasia and macronodular adrenal hyperplasia may also be associated with bilateral adrenal masses. Imaging is usually unrewarding for establishing the aetiological diagnosis, except for the presence of calcification which may point towards the diagnosis of tuberculosis or histoplasmosis. Fine needle aspiration cytology is useful in patients with bilateral adrenal masses, especially in the presence of adrenal insufficiency.