Chronic Disseminated Histoplasmosis in an Immunocompetent Man Presented as Bilateral Adrenal Masses with Partial Adrenocortical Insufficiency - A Rare Condition

Bilateral adrenal masses caused by histoplasmosis is a rare condition. To our knowledge this is the first case report of bilateral adrenal enlargement by histoplasmosis in Bangladesh. We report a case of 75 years old man who presented with low grade fever, night sweating, anorexia and progressive weight loss for 9 months prior to admission in Square Hospital. Clinical profile was unremarkable apart from low grade fever (with maximum temperature recorded up to 101ºF) and low blood pressure with significant postural drop. Plasma cortisol (morning and evening) and glucose were normal but short ACTH stimulation test revealed low plasma cortisol response. Abdominal ultrasound gave a definite clue of left adrenal mass which was later found as bilateral adrenal masses of significant size by abdominal CT scan. Initially Gomoris Methenamine Silver (GMS) stain of CT guided FNAC of the left adrenal mass showed small budding yeast morphologically consistent with histoplasmosis. A second CT guided FNAC of both adrenal masses also showed similar findings which was finally confirmed by fungus culture as Histoplasma capsulatum. The patient was then treated with injection amphotericin-B followed by oral itraconazole and fludrocortisone and he responded well DOI: http://dx.doi.org/10.3329/jbcps.v29i4.11345 J Bangladesh Coll Phys Surg 2011; 29: 235-240

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Myofibrosarcoma of the Adrenal Gland

The American Surgeon ◽

10.1177/000313480507100302 ◽

2005 ◽

Vol 71 (3) ◽

pp. 191-193

Author(s):

S.A. Mclaughlin ◽

T.M. Schmitt ◽

K.L. Huguet ◽

D.M. Menke ◽

J.H. Nguyen

Keyword(s):

Adrenal Gland ◽

Adrenal Mass ◽

Soft Tissues ◽

Malignant Tumors ◽

Low Grade ◽

En Bloc ◽

First Case ◽

Pathologic Features ◽

Adrenal Masses ◽

The Right

Adrenal masses have varying presentations. Most commonly, adrenal masses are discovered incidentally on CT or MRI during an evaluation for an unrelated complaint. Although the majority of these are nonfunctional cortical adenomas, hormonally active tumors and adrenocortical carcinoma must also be considered in the differential diagnosis. Rarely, retroperitoneal tumors may mimic an adrenal mass. We report a case of a 49-year-old man with anemia and weight loss who was found to have a large retroperitoneal mass arising from the adrenal gland. Surgical treatment involved en bloc resection of the right kidney, adrenal gland, segments 7 and 8 of the liver, and a portion of the right hemidiaphragm. Final pathology revealed a low-grade myofibrosarcoma. We believe that this is the first case report of a myofibrosarcoma of the adrenal gland. Myofibrosarcomas are rare malignant tumors composed of myofibroblasts that arise from the deep soft tissues. These tumors have a predilection for the head and neck, trunk, or extremities. Myofibrosarcomas can be differentiated from other sarcomas by immunohistochemical staining and pathologic features. We will briefly discuss the workup of an adrenal mass and focus on the diagnosis of myofibrosarcoma.

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A Case Report on Bilateral Adrenal Histoplasmosis

Bangladesh Journal of Urology ◽

10.3329/bju.v23i2.50317 ◽

2020 ◽

Vol 23 (2) ◽

pp. 210-212

Author(s):

Md Sazzad Hossain ◽

Mohammad Zahid Hasan ◽

Mir Ehteshamul Haque ◽

Mostakim Maoya

Keyword(s):

Adrenal Mass ◽

Adrenal Glands ◽

Histoplasma Capsulatum ◽

Needle Aspiration ◽

Immunosuppressed Patient ◽

Aspiration Cytology ◽

Fine Needle ◽

Disseminated Histoplasmosis ◽

Adrenal Masses ◽

Needle Aspiration Cytology

Disseminated histoplasmosis affecting the adrenal glands is a very rare infection and an uncommon cause of adrenal insufficiency. We present a case of bilateral adrenal histoplasmosis in a 77 years old immunosuppressed patient who presented with bilateral adrenal masses. The fine needle aspiration cytology of the adrenal mass was positive for Histoplasma capsulatum. Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.210-212

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SAT-221 50-Year-Old Fungus Suddenly Flourishes in Adrenal Glands: A Case of Sudden-Onset Bilateral Adrenal Masses Due to Latent Disseminated Histoplasmosis

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.753 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Maritza Elide Carrillo ◽

Amy Chang ◽

Christopher L Walsh

Keyword(s):

Adrenal Glands ◽

Histoplasma Capsulatum ◽

Rapid Development ◽

Granulomatous Inflammation ◽

Fungal Culture ◽

Travel History ◽

Disseminated Histoplasmosis ◽

First Case ◽

Free Cortisol ◽

Adrenal Masses

Abstract Histoplasma capsulatum is endemic to Africa, Asia, Central and South America, and within the US, to the Ohio and Mississippi River Valley. Disseminated histoplasmosis is less commonly seen in immunocompetent individuals, who usually present with asymptomatic self-limited acute pneumonitis. Time to involvement of the adrenals is unknown. Adrenal insufficiency occurs in 45% of cases involving the adrenals, and is thought to be irreversible even in patients in remission. A 76-year-old man with no significant past medical history was incidentally found to have large bilateral adrenal masses during routine surveillance of a 7 mm pulmonary nodule on annual Chest CT, which showed normal adrenal glands the year prior. He was asymptomatic. A lifetime non-smoker native to California, whose only significant travel history was in his 20s to Ecuador and Puerto Rico, areas endemic to Histoplasma. Abdominal CT showed large bilateral adrenal masses with intermediate density and low washout values (right: 4.9 cm, HU 45, absolute washout 30%; left: 4.8 cm, HU 30, absolute washout 25%). On exam, vital signs were stable with normal orthostatics. Labs revealed normocytic anemia, normal chemistry panel, normal cortisol after 1-mg dexamethasone overnight test 2.6 mcg/dL (n<5 mcg/dL), plasma metanephrine <0.10 nmol/L (n <0.50 nmol/L), plasma normetanephrine 0.89 nmol/L (n <0.90 nmol/L), aldosterone 4.0 ng/dL (n <31 ng/dL), PRA 2.0 ng/ml/hr (n 0.5-4 ng/ml/hr) and random free cortisol 0.38 ug/dL (n 0.022-0.254ug/dL). HIV antigen and antibody, and Histoplasma urinary antigen were negative. Left adrenal mass biopsy revealed necrotizing granulomatous inflammation with fungal culture revealing budding yeast morphologically consistent with Histoplasmosis, with DNA probe confirming Histoplasma capsulatum. Treatment with itraconazole was initiated and the patient is tolerating the treatment well. To our knowledge, this is the first case demonstrating rapid development of large bilateral adrenal masses within a year due to latent disseminated histoplasmosis in an asymptomatic individual, which highlights the need for appropriate testing in patients with known exposure or travel history to endemic areas, regardless of time since exposure. 1.Singh M, Chandy DD, Bharani T, Marak RSK, Yadav S, Dabadghao P, et al. Clinical outcomes and cortical reserve in adrenal histoplasmosis- a retrospective follow-up study of 40 patients. Clin Endocrinol 2019 Jan 17

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Plasma 11b,17a,21-Trihydroxypregn-4-ene-3,20-dione as Blood Biomarker Assay. A controlled study

Revista de Chimie ◽

10.37358/rc.19.10.7587 ◽

2019 ◽

Vol 70 (10) ◽

pp. 3515-3517

Author(s):

Edwin Sever Bechir ◽

Mihaela Jana Tuculina ◽

Mara Carsote ◽

Ionela Teodora Dascalu ◽

Mihaela Raescu ◽

...

Keyword(s):

Adrenal Mass ◽

Plasma Cortisol ◽

Adrenal Glands ◽

Glycated Haemoglobin ◽

Controlled Study ◽

Control Group ◽

Haemoglobin A1c ◽

Blood Biomarker ◽

Menopausal Women ◽

Adrenal Masses

11b,17a,21-Trihydroxypregn-4-ene-3,20-dione or cortisol (C21H30O5) represents the product of adrenal glands and in humans its assessment is a useful tool for evaluation of glucocorticoid axes. Our purpose is to evaluate the profile of morning plasma cortisol/ACTH/ionogram in menopausal women with non-functioning adrenal tumours. A controlled study of 193 menopausal women found that BMI is statistically significant higher versus control in subjects with unilateral, respective bilateral adrenal non-secretor tumours. Baseline C21H30O5 is similar between the groups while ACTH is decreased when compare with control group indicating a potential persistent cortisol tumour-related exposure. Glycated haemoglobin A1c is increased in group with single adrenal mass (versus control) while serum sodium is higher in group with double adrenal masses (versus control).

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SUN-173 A Gigantic Uterine Leiomyoma and Big Bilateral Adrenal Myelolipomas as a Result of Untreated Congenital Adrenal Hyperplasia

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.318 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Betty La ◽

Ha Nguyen ◽

Celestine Tung ◽

Eugene Choi

Keyword(s):

Congenital Adrenal Hyperplasia ◽

Adrenal Insufficiency ◽

Adrenal Mass ◽

Uterine Leiomyoma ◽

Pelvic Mass ◽

Treatment Compliance ◽

Total Testosterone ◽

Adrenal Hyperplasia ◽

Acth Stimulation ◽

Adrenal Masses

Abstract Introduction Patients with untreated congenital adrenal hyperplasia (CAH) can present early with severe symptoms of salt wasting, adrenal insufficiency and hyperandrogenism. Late consequences as a result of long term untreated CAH are rarely seen nowadays. We present a patient who presented with a massive uterine leiomyoma and bilateral adrenal myelolipomas due to longstanding treatment noncompliance. Clinical Case A female was born with ambiguous genitalia and diagnosed with CAH at birth. She was raised as a female and received steroids until age 29 when she stopped taking steroids on her own with the intention of identifying as a male. At age 37, he presented with abdominal distension, vomiting, and hypotension. Physical exam was notable for hypotension, significantly distended abdomen, hirsutism, gynecomastia and clitoromegaly. Labs revealed sodium 126 meq/L (136–145) cortisol 78.5 ug/dL (3.7–19.4), ACTH 166 pg/mL (6–50), 17-hydroxyprogesterone 4356 ng/dL (≤285), androstenedione 7188 ng/dL (35–250), total testosterone 737 ng/dL (2–45), estradiol 142 pg/mL (48–440), aldosterone <1 ng/dL (3–16), renin 0.45 ng/mL/hr (0.25–5.82), metanephrines 56 pg/mL (≤205), normetanephrines 56 pg/mL (≤148). CT abdomen and pelvis revealed a large 31 x 35 x 31 cm pelvic mass, a 5.9 x 2.4 cm right adrenal mass and an 11.8 x 8.8 cm left adrenal mass. The patient underwent total abdominal hysterectomy and bilateral adrenalectomy. Pathology of the pelvic mass was consistent with uterine leiomyoma (gross tumor was 12.4 kg) and pathology of the bilateral adrenal masses were consistent with bilateral adrenal myelolipomas. Discussion Glucocorticoids and mineralocorticoids are the mainstays of treatment in CAH, with the goal of providing adequate replacement while reducing levels of ACTH and adrenal androgens. Persistently elevated levels of ACTH and androgens can lead to many serious sequela, even outside of adrenal insufficiency and virilization. Due to the conversion of androgens to estrogens, untreated females with CAH have significantly elevated levels of both hormones. These high levels of androgens and estrogen can then stimulate growth of estrogen-dependent organs as exemplified by our patient. Chronic ACTH stimulation can cause adrenal hyperplasia, but has also been associated with the development of other adrenal masses including adrenal myelolipomas. Adrenal myelolipomas can become hormonally functional or cause mass effect, hemorrhage, necrosis when reaching a large enough size. Conclusion This case demonstrates the importance of CAH treatment compliance as there are many serious sequela outside of the expected adrenal insufficiency and virilization. Even when the desired effect is virilization with physical male features, other means of hormonal therapy should be considered as there remains the risks of abnormal growth of certain organs sensitive to the excessive hormones.

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Suspected bilateral adrenal gland tumour causing primary Addison’s disease in a dog

Tierärztliche Praxis Ausgabe K Kleintiere / Heimtiere ◽

10.1055/a-1122-7837 ◽

2020 ◽

Vol 48 (02) ◽

pp. 132-138

Author(s):

Anna-Lena Proksch ◽

Andreas Brühschwein ◽

Katrin Hartmann ◽

Astrid Wehner

Keyword(s):

Adrenal Gland ◽

Vena Cava ◽

Kidney Injury ◽

Addison’S Disease ◽

Abdominal Ultrasound ◽

Surgical Removal ◽

Addison's Disease ◽

Acth Stimulation ◽

First Case ◽

Adrenal Masses

AbstractA 13-year old miniature poodle presented with a 3-day episode of vomiting, anorexia, and lethargy. Lack of micturition had been noted for 2 days. Clinical examination indicated dehydration and a tense, painful abdomen. Laboratory parameters (severe azotaemia, hyperkalaemia, severe hyponatraemia, hypochloraemia, and hyperphosphataemia with glucosuria and proteinuria) were consistent with anuric acute kidney injury (AKI). Abdominal ultrasound revealed bilateral adrenal masses. ACTH stimulation test was diagnostic for Addison’s disease. Computed tomography confirmed bilateral adrenal masses and indicated multifocal liver nodules. Additionally, infiltration of the caudal vena cava with partial luminal occlusion was demonstrated. Surgical removal of the adrenal masses with venous plasty intervention and stenting of the vessels deemed unrewarding in this patient in respect to progressed tumour growth with assumed metastatic spread. The dog was treated for Addison’s disease and discharged with good overall condition. Eight weeks later, the dog was euthanized due to progressive caudal vena cava occlusion. Whilst hypoadrenocoticism typically affects young to middle aged dogs, in old dogs primary Addison’s disease might be caused by neoplastic bilateral adrenal gland destruction. This is the first case report of hypovolaemia leading to AKI secondary to bilateral adrenal masses causing Addison’s disease in a dog.

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Adrenal Lymphoma: Case Report and Review of Literature

World Journal of Endocrine Surgery ◽

10.5005/jp-journals-10002-1020 ◽

2010 ◽

Vol 2 (1) ◽

pp. 39-43 ◽

Cited By ~ 2

Author(s):

Jaya Bhanu Kanwar

Keyword(s):

Weight Loss ◽

Adrenal Insufficiency ◽

Adrenal Mass ◽

Serum Lactate ◽

Normal Serum ◽

Serum Lactate Dehydrogenase ◽

Chop Regimen ◽

First Case ◽

Adrenal Lymphoma ◽

Adrenal Masses

ABSTRACT Adrenal lymphoma is a rare diagnosis in subject presenting with bilateral adrenal masses. Adrenal insufficiency is a common complication of this disease. Most cases of primary adrenal lymphoma (PAL) present with adrenal insufficiency and huge bilateral adrenal masses. These are very aggressive tumors with poor prognosis. We, hereby, report two subjects of adrenal lymphoma presenting with bilateral adrenal masses. First case is a 50 years old male presented with features of adrenal insufficiency like anorexia, weight loss, nausea, vomiting, and generalized hyperpigmentation. Routine investigations revealed hyponatremia, normal serum K; serum lactate dehydrogenase was moderately elevated. Primary adrenal insufficiency was confirmed by low basal and cosyntrophin stimulated cortisol. CT abdomen revealed huge bilateral heterogeneous enlargement of adrenal glands. Lymphoma was confirmed by histopathology and immunohistochemistry, diagnosis of PAL was made after further staging. He was treated with Rituximab-CHOP regimen. Second case, 50 years old lady presented with fever, anorexia, weight loss. She had generalized lymphadenopathy. On imaging found to have bilateral adrenal mass, and histopathology from lymph node, breast mass and adrenal mass was suggestive of non-Hodgkin's lymphoma.

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Plasma 11b,17a,21-Trihydroxypregn-4-ene-3,20-dione as Blood Biomarker Assay. A controlled study

Revista de Chimie ◽

10.37358/rc.19.10.3515 ◽

2019 ◽

Vol 70 (10) ◽

pp. 3515-3517

Keyword(s):

Adrenal Mass ◽

Plasma Cortisol ◽

Adrenal Glands ◽

Glycated Haemoglobin ◽

Controlled Study ◽

Control Group ◽

Haemoglobin A1c ◽

Blood Biomarker ◽

Menopausal Women ◽

Adrenal Masses

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A confluence of rarities: post sedation neuroexcitation following adrenal perineurioma resection

Case Reports in Clinical Pathology ◽

10.5430/crcp.v8n1p40 ◽

2021 ◽

Vol 8 (1) ◽

pp. 40

Author(s):

Vivek Somasundaram ◽

Matthew C. Hernandez ◽

Blake A. Ebner ◽

Andrew L. Folpe ◽

Joaquin J. Garcia ◽

...

Keyword(s):

Case Report ◽

Adrenal Mass ◽

Clinical Spectrum ◽

First Case ◽

Adrenal Masses

Adrenal masses are frequently discovered incidentally and warrant further workup to explore the etiology of the mass. We present the case of a patient who had an incidentally discovered nonfunctional adrenal mass, which was determined to be a perineurioma. This is the first case report, to our knowledge of a perineurioma occurring in this location. Additionally, we report an episode of post sedation excitation, or “propofol frenzy” in the same patient to add to the clinical spectrum of presentation of this phenomenon.

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A Case Report of HIV-Related Bilateral Inflammatory Myofibroblastic Tumors of Adrenal Gland

10.21203/rs.3.rs-942058/v1 ◽

2021 ◽

Author(s):

Mengmeng Zhang ◽

Hui Liu ◽

Zhiqiang Zhu ◽

Yu Zhang ◽

Yanyan Zhang

Keyword(s):

Adrenal Gland ◽

Hiv Infection ◽

Highly Active Antiretroviral Therapy ◽

Inflammatory Infiltration ◽

Ct Guided ◽

Highly Active ◽

First Case ◽

Inflammatory Myofibroblastic Tumors ◽

Adrenal Masses ◽

Severe Immunodeficiency

Abstract Inflammatory myofibroblastic tumor (IMT) is a rare disease which mostly occurs at younger age and locates in lung in general population. We report a rare case of 44-year-old man diagnosed adrenal IMT with HIV infection, who refused regular highly active antiretroviral therapy (HAART) 13 years ago until in hospital because of findings of adrenal masses. The patient underwent CT-guided needle biopsy successfully, and the pathological analysis documented the diagnosis of IMT by the feature of proliferation of fibroblastic-myofibroblastic with inflammatory infiltration. We failed to perform tumor complete resection due to diffuse invasion of tumor under laparoscope. The patient was complicated with severely multiple pulmonary infection post to surgery because of immunodeficiency, that eventually caused the death of patient 2 months later. This case reminds us that IMTs may be too aggressive and progressed in HIV-positive patients with irregular HAART to perform surgical resections, and severe immunodeficiency can be more fatal. To our knowledge, this case is the second IMT patient with HIV infection worldwide, but the first case occurs at adrenal gland rather than lung in adult.

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