FRI246 A Rare Case Of An Adrenal Gland Hemangioma In A 68-year-old Female

Abstract

Abstract Disclosure: R. Daas: None. S. Logan: None. R. Voss: None. V. Tarasova: None. T. Glushko: None. J. Hernandez Prera: None. S. Agosto Salgado: None. J. Hallanger-Johnson: None. C. Veloski: None. Background: Adrenal gland hemangiomas are extremely rare, with less than one hundred cases reported in the literature. Although benign and usually asymptomatic, they can be confused with adenomas, pheochromocytomas, or malignant adrenal tumors and preoperative diagnosis is challenging. Clinical Case: A 68-year-old female with a history of breast cancer completes an abdominal/ pelvic MRI due to abdominal and back pain that reveals a 1.4 cm right adrenal mass with T2 bright enhancement prompting concern for pheochromocytoma, lipid poor adenoma, or metastasis. An adrenal protocol contrast CT abdomen redemonstrated a 1.3 cm brightly enhancing right adrenal nodule with precontrast Hounsfield units (HU) of 35, postcontrast HU of 236, and delayed HU of 81. Absolute washout was 77.1%, consistent with an adenoma, however, the enhancement profile was also concerning for pheochromocytoma. Labs showed ACTH 15.2 pg/mL (7.2 - 63.3 pg/mL), cortisol 14.7 ug/dL (3.7 - 19.4 ug/dL), dexamethasone suppression test with cortisol 1.3 ug/dL (3 – 41 ug/dL), aldosterone 12 ng/dL (4.0 - 31.0 ng/dL), renin 0.1 ng/mL/hr (0.5 - 4.0 ng/mL/hr), potassium 4.0 mmol/L (3.4 - 4.5 mmol/L), DHEA-S 122 ug/dL (9 - 246 ud/dL), total testosterone 41.38 ng/dL (3.00 – 41.00 ng/dL), free testosterone 3.7 pg/mL (0.6 - 3.8 pg/mL), plasma normetanephrines 0.82 nmol/L (0 - 0.89 nmol/L), and plasma metanephrines 0.14 nmol/L (0 - 0.49 nmol/L), 24-hour urine: norepinephrine 47 ug/d (14 – 120 ug/d), epinephrine <4 ug/d (1 – 14 ug/d), dopamine 236 ug/d (71 – 485 ug/d), metanephrines 86 ug/d (36 – 229 ug/d), and normetanephrines 258 ug/d (95 – 650 ug/d). The patient was asymptomatic, without high blood pressure, tachycardia, or hypokalemia. Despite the unremarkable lab workup, surgical excision of the nodule was recommended due to concern for silent pheochromocytoma or metastasis given the imaging findings and history of breast cancer. She was pretreated with doxazosin and had a right adrenalectomy. Pathology revealed a 1 cm hemangioma involving the periadrenal adipose tissue with ERG positive, CD31 positive, and D2-40 negative immunohistochemical staining. She was monitored post-operatively for transient hypotension and tachycardia and was discharged in stable condition. Conclusion: The differential diagnosis for adrenal gland incidentalomas is quite broad, however, patient history, along with laboratory and imaging studies, can help guide management. Adrenal gland hemangiomas are rare, non-functional, and have a propensity to bleed, but are benign and have a good prognosis. Presentation: Friday, June 16, 2023