A Diagnostic Conundrum: A Hemorrhagic Adrenal Mass With Discordant Radiological, Biochemical, and Pathologic Features
Year: 2026
Type: article
Study design: Case Report
Abstract: Background: Adrenal incidentalomas vary in their identity, making accurate diagnosis essential for management. Interpretation of these lesions using radiology, biochemistry, or pathology can be confounded by hemorrhagic changes, medication effects, and limitations of imaging. To prevent misclassification, an integrated assessment is crucial. Case Report: We present a case of a 71-year-old male with an incidentally discovered left adrenal mass that exhibited computed tomography and MRI imaging findings concerning for pheochromocytoma or adrenal malignancy. Discussion: Biochemical analysis ruled out pheochromocytoma and was suggestive of possible glucocorticoid and mineralocorticoid co-secretion, although clinical urgency of surgical resection precluded completion of confirmatory endocrinologic testing. The lesion was initially diagnosed as a benign endothelial adrenal cyst on pathologic review. Because of the discordance among the radiological, biochemical, and initial pathologic findings, an integrated histologic re-evaluation was requested. The mass was ultimately reclassified as an adrenocortical adenoma with extensive hemorrhagic and cystic changes. Conclusion: This case highlights the importance of multidisciplinary integration when evaluating adrenal lesions with confounding features and underscores how suggestive (though incomplete) biochemical evidence can appropriately drive pathological re-evaluation.
Source: AACE Endocrinology and Diabetes
Institution: The University of Texas Medical Branch at Galveston
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7167631755