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BMJ Case Rep. 2010; 2010: bcr10.2009.2347.
Published online Jan 13, 2010. doi:  10.1136/bcr.10.2009.2347
PMCID: PMC3027821
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Bilateral adrenal masses: varying aetiologies
Anil Bhansali,1 Prem Kumar,1 Rama Walia,1 Vimal Upreti,1 Niranjan Khandelwal,2 Pranab Dey,3 and Sambit Das1
1PGIMER, Endocrinology, UT, Chandigarh, 160012, India
2PGIMER, Radiology, UT, Chandigarh, 160012, India
3PGIMER, Cytology, UT, Chandigarh, 160012, India
Anil Bhansali, anilbhansali_endocrine/at/rediffmail.com
We describe three cases of bilateral adrenal masses with different aetiologies. Their clinical details are provided in table 1.
Table 1
Table 1
Clinical details
Figure 1
Figure 1
(A) Contrast enhanced abdominal computed tomography (CT) scan showing bilateral adrenal masses (right adrenal 4.4×2.2 cm and left adrenal 2.2×1.6 cm) with a speck of calcification. (B) Fine needle aspiration cytology smear showing granulomatous (more ...)
Figure 2
Figure 2
(A) Contrast enhanced abdominal CT scan showing bilateral adrenal masses (right adrenal 4.3×2 cm and left adrenal 4.9×3 cm); no lymphadenopathy. (B) Fine needle aspiration cytology smear showing periodic acid-Schiff (PAS) positive rounded (more ...)
Figure 3
Figure 3
(A) Contrast enhanced abdominal CT scan showing bilateral adrenal masses (right adrenal 9.2×5 cm and left adrenal 7.5×4.9 cm) with periaortic lymphadenopathy. (B) Fine needle aspiration cytology smear showing discrete immature lymphoid (more ...)
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.
Footnotes
Competing interests: None.
Patient consent: Patient/guardian consent was obtained for publication.
REFERENCES
1. Kawashima A, Sandler CM, Fishman EK, et al. Spectrum of CT findings in nonmalignant disease of the adrenal gland. Radiographics 1998; 18: 393–412. [PubMed]
2. Mukherjee JJ, Villa ML, Tan L, et al. Bilateral adrenal masses due to histoplasmosis. J Clin Endocrinol Metab 2005; 90: 6725–6. [PubMed]
3. Kita M, Mandala E, Saratzis A, et al. Primary adrenal lymphoma presenting as Addison’s disease. Case report and review of the literature. Exp Clin Endocrinol Diabetes 2008; 116: 363–5. [PubMed]
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