Post-operatory contra-lateral incidental imaging finding following laparoscopic surgery for adrenal Cushing syndrome

Introduction: Adrenal incidentaloma may be found on otherwise non-related conditions. If revealing a contra-lateral tumour on a patient who priory had an adrenalectomy may be consider accidental it is difficult to establish.

Case report: This is a 51-year male with long-term history of high blood pressure, diabetes mellitus, and dyslipidemia. He was referred for an endocrine check-up because of Cushing’s syndrome (CS) suspicion. Low Adrenocorticotropic Hormone and non- suppression to all Dexamethasone tests pointed an adrenal CS. Abdominal CT (computed tomography) scan showed a right adrenal tumour of 39 25 mm (millimetre). Right adrenalectomy was performed through a laparoscopic approach three months after initial diagnosis. No complication was registered during the procedure. The pathological report confirmed a corticoadrenal adenoma. No adrenal insufficiency was diagnosed. First endocrine assessment showed normal adrenal axes and an improvement of glucose profile. Nine month after surgery, laboratory tests were normal but CT scan showed a left adrenal mass of 25 21 13 mm and normal post-operatory aspect at the level of right adrenal bed. For the moment, it was considered an incidentaloma which was not revealed at first CT scan (performed without intravenous contrast) due to low chance of aggressive increase since the initial imagery scan, noting the benign aspect at pathological report regarding right adrenal tumour. Serial tight endocrine and imagery follow-up was considered imperious.

Conclusion: The field of adrenal CS is complex. Whether a nonsecretor contra-lateral tumour was indentified after an adrenocortical adenoma was laparoscopically removed or the tumour escaped the initial imagery scan it is difficult to establish but paying close attention to endocrine and radiological changes is essentially needed.

Abbreviations: ACTH = Adrenocorticotropic hormone, Adrenal Incidentaloma = AI, CS = Cushing’s syndrome, CT = Computed Tomography, MRI= Magnetic Resonance Imaging, mm= millimeters, mg = miligram