Adrenal Insufficiency and Adrenal Cancer

Abstract

A 43-yr-old male initially presented to his primary care physician with the complaint of 3 d of right-sided abdominal pain. The pain was dull, located diffusely in the right upper quadrant of his abdomen and flank, and at times penetrated to the back. He denied any relation of the pain to food intake. In addition, he denied any jaundice, nausea, vomiting, fevers, or chills. His exam was unremarkable with the exception of mild right upper quadrant abdominal pain with moderate palpation. His physician was concerned with the possibility of gall bladder pathology, and pursued an abdominal ultrasound of the right upper quadrant. The ultrasound revealed no evidence of biliary disease, but an incidental finding of a right adrenal mass, measuring approximately 2 cm, was noted (see Fig. 1). No further testing was performed, and the patient’ s pain resolved without therapy. Approximately 3 yr later, the patient again presented with pain located in his right upper abdomen, similar to his previous episode. An ultrasound of the biliary tract was performed, and revealed two gallstones, without signs of obstruction or inflammation. The incidental right adrenal nodule was again noted, and measured at 3 cm in size. Subsequently, an abdominal and pelvic computerized tomography (CT) scan was performed without contrast and revealed a 3.5-cm homogeneous right adrenal mass, rounded in configuration, with attenuation slightly less than the adjacent liver (20 Hounsfield units). No other masses or adenopathy were seen, and the contralateral adrenal gland was normal in appearance.