Unilateral exophthalmos and hypothyroidism

Radiographic findings may be very helpful in deciding adequate management. A cystic image with fluid contents and an attenuation coefficient similar to water containing calcifications (occurring in up to 15% of cases) may suggest an adrenal cyst. Rozenblit et al. classified nonfunctioning cystic adrenal masses into four types based on radiographic criteria. Uncomplicated cysts are homogeneous cysts less than 6 cm in size and with a wall less than 3mm thick; for this variety, regular monitoring is recommended to detect changes in nature or size. Complicated cysts are those with high attenuation values or non-homogeneous, with walls thicker than 5mm or with central or peripheral thick calcifications. Surgery is recommended for these cysts. Cysts greater than 5--6 cm in size with attenuation values higher than water or with wall thicknesses between 3 and 5 cm are considered indeterminate cysts. For these, lesion puncture or conservative management may be indicated.5 Fine needle aspiration (FNA) may be helpful for classifying the type of adrenal cyst or for differentiating it from cysts with other origins (liver, etc.).6 FNA should never be performed for lesions suspected of being parasitic cysts or pheochromocytoma. According to Neri and Nance, this procedure may improve compression symptoms in some patients while avoiding surgical resection.6 However, other authors think that FNA has a very limited role for establishing lesion malignancy, and that only the pathological study of surgical specimens can provide a definitive diagnosis.7 In our patient, surgery was decided upon because the CT image suggested amalignant lesion. However, an endothelial cyst was found. Cyst removal was also associated with an improvement in the symptoms which had led the patient to seek medical help. Although they are not the most common etiology of incidental adrenal masses, these cysts should be considered in differential diagnosis and when treatment is being decided. Conflicts of interest