Content area
Full text
Received Feb 26, 2018; Revised Apr 9, 2018; Accepted Apr 15, 2018
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
1. Introduction
Adrenal hemangiomas are rare benign nonfunctional tumors typically found incidentally with imaging. Since the first reported case in 1955, there have been about 90 reported cases in the literature [1]. Most adrenal hemangiomas are cavernous, while a rare capillary type has also been seen [2]. Patients are usually asymptomatic, though the lesion carries a small risk of spontaneous hemorrhage. Adrenal hemangiomas are radiographically difficult to distinguish from adrenocortical carcinoma and usually undergo surgical resection for this reason.
2. Case Presentation
A 64-year-old white male with no prior medical history presented to his primary care physician for routine follow-up. There was no history of hypertension. During work-up for elevated liver transaminases, he was found to have hepatitis C. Before initiation of Harvoni, he underwent CT imaging of the abdomen with contrast which found a 5 × 6.7 × 7 cm right adrenal mass (Figure 1). On physical examination, he was afebrile with a pulse of 47 and normotensive at 118/68. His abdominal exam was nontender, nondistended, without masses, or hernias. Review of systems was negative for abdominal pain, hypertension, weakness, palpitations, headache, diaphoresis, or weight gain. He was a current smoker with a 33 pack-year history. He had no history of endocrine disease. His family history was significant only for a father with pancreatic cancer. His remaining laboratory values were within normal values including a normal potassium value. The patient was seen by the endocrine service for evaluation, and biochemical work-up revealed that the ACTH level was 9.1 pg/ml (nl 7.2–63.3); AM cortisol was normal at 10.01 mcg/dl, and 24-hour urine metanephrines was less than 50 mcg (nl).
[figure omitted; refer to PDF]On CT imaging, the right adrenal mass contained scattered calcifications with small regions of fat. It enhanced in a peripheral globular fashion with central progression. The absolute contrast washout of 22.9% was indeterminate for adrenal adenoma (Figure 1). The mass was noted to abut but did not appear to invade the adjacent liver, right kidney, and inferior vena cava. There was no adenopathy or free fluid. There...