Advertisement

Journal of Endocrinological Investigation

, Volume 23, Issue 7, pp 476–479 | Cite as

Adrenal bilateral incidentaloma by reactivated histoplasmosis

  • Serafino Lio
  • M. Cibin
  • R. Marcello
  • M. A. Viviani
  • L. Ajello
Case Report

Abstract

We report a case of bilateral adrenal incidentaloma caused by the capsulatum variety of Histoplasma capsulatum diagnosed in a 74 years old man born in and a life time resident of Treviso, Italy, with the exception of two years spent in Pakistan (1964–1966) as a well-driller. The patient was hospitalized in 1995 for alcoholic chronic hepatitis, chronic Helicobacter pylori gastritis and post-infarction ischemic cardiomyopathy. Abdominal ultrasound incidentally showed bilateral adrenal masses (the right one 6.3 cm in diameter) confirmed by computed tomography, with adrenal function within normal limits. After three months, the patient was again hospitalized due to evening fever, asthenia, anorexia, weight loss and occasional hyperhidrosis. Abdominal ultrasound showed an increase of the right adrenal lesion with normal adrenal function. Ultrasound-guided fine needle aspiration did not prove useful for diagnosis. Accordingly, a laparotomy with bilateral biopsy was performed; histology showed the presence of numerous tissue form cells of H. capsulatum variety capsulatum. Serum anti-H. capsulatum antibodies were negative. Since March, 1996, the patient was given itraconazole and his symptoms quickly regressed but the computed tomography findings, however, have not changed and the patient has adrenal hypofunction that is being treated with cortisone acetate.

Key-words

Adrenal incidentaloma histoplasmosis 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Griffing G.T. A.I.D.S.: the new endocrine epidemic (Editorial). J. Clin. Endocrinol. Metab. 1994, 79: 1530–1531.PubMedGoogle Scholar
  2. 2.
    Copeland P.M. The incidentally discovered adrenal mass. Ann. Intern. Med. 1983, 98: 940–945.PubMedCrossRefGoogle Scholar
  3. 3.
    Ross N.S., Aron D.C. Hormonal evaluation of patients with an incidentally discovered adrenal mass. N. Engl. J. Med. 1990, 323: 1401–1405.PubMedCrossRefGoogle Scholar
  4. 4.
    Kloss R.T., Gross M.D., Francis I.R., Korobkin M., Shapiro B. Incidentally discovered adrenal mass. Endocr. Rev. 1995, 16: 460–484.Google Scholar
  5. 5.
    Cook D.M. Adrenal mass. Endocrinol. Metab. Clin. North Am. 1997, 26: 829–852.CrossRefGoogle Scholar
  6. 6.
    Angeli A., Osella G., Ali A., Terzolo M. Adrenal incidentaloma: an overview of clinical and epidemiology data from the National Italian Study Group. Horm. Res. 1997, 47: 279–283.PubMedCrossRefGoogle Scholar
  7. 7.
    Barzon L., Scaroni C., Sonino N., Fallo F., Gregianin M., Macrì C., Boscaro M. Incidentally discovered adrenal tumors: endocrine and scintigrafic correlates. J. Clin. Endocrinol. Metab. 1998, 83: 55–62.PubMedGoogle Scholar
  8. 8.
    Vago G., Antinori S., Viganò M.G., Pometta R., Faggi E., Oreste P.L., Farina C., Rivasi F., Chiodera A., Viviani M.A., Morace G. La sorveglianza dell’istoplasmosi del Gruppo di studio FIMUA-CEMM. In: Programma e Relazioni del 4° Congresso Nazionale della FIMUA, Milano 10–12 dicembre 1998, Abstract R. 16, p. 21.Google Scholar
  9. 9.
    Sherlock S. Alcohol and the liver. In: Sherlock S. (Ed.), Disease of the liver and biliary system. Blackwell Scientific Publication, Oxford, 1989, p. 425.Google Scholar
  10. 10.
    Osella G., Terzolo M., Borretta G., Magro G.P., Ali A., Piovesan A., Paccotti P., Angeli A. Endocrine evaluation of incidentally discovered adrenal masses (incidentalomas). J. Clin. Endocrinol. Metab. 1994, 79: 1532–1539.PubMedCrossRefGoogle Scholar
  11. 11.
    Peppercorn P.D., Grossman A.B., Reznek R.H. Imaging of incidentally discovered adrenal masses. Clin. Endocrinol. (Oxf.) 1998, 48: 379–388.CrossRefGoogle Scholar
  12. 12.
    Flecchia D., Mazza E., Carlini M., Blatto A., Olivieri F., Serra G., Camanni F., Messina M. Reduced serum levels of dehydroepiandrosterone sulphate in adrenal incidentaloma: a marker of adre-nocortical tumor. Clin. Endocrinol. (Oxf.) 1995, 42: 129–134.CrossRefGoogle Scholar
  13. 13.
    Washburn R.G., Bennett J.E. Reversal of adrenal glucocorticoid dysfunction in a patient with disseminated histoplasmosis. Ann. Intern. Med. 1989, 110: 86–87.PubMedCrossRefGoogle Scholar
  14. 14.
    Lee J., Jones P.H., Trowell J.E., Whitear W.P., Williams P.F. Hypoadrenal crisis caused by disseminated histoplasmosis. J. Infect. 1993, 27: 181–183.PubMedCrossRefGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2000

Authors and Affiliations

  • Serafino Lio
    • 1
  • M. Cibin
    • 1
  • R. Marcello
    • 1
  • M. A. Viviani
    • 2
  • L. Ajello
    • 3
  1. 1.Divisione Medicina GeneraleOspedale CivileOderzo (TV)Italy
  2. 2.Istituto di Igiene e Medicina Preventiva, IRCCS-Ospedale MaggioreUniversità degli Studi di MilanoItaly
  3. 3.Department of OphtalmologyEmory University School of MedicineAtlantaUSA

Personalised recommendations