[Adrenal ganglioneuroma: clinical and surgical dilemma concerning an incidental finding].

Ganglioneuroma is a benign neoplasm derived from the neural crest consisting of mature ganglionic cells and Schwann cells. The posterior mediastinum is its most common location, followed by the retroperitoneum. Only a small proportion of ganglioneuromas arise from the adrenal medulla (15--30%). The routine use of imaging tests has increased the frequency of diagnosis of adrenal incidentalomas. Most of these lesions are nonfunctional benign adenomas. Other less common lesions include cortisol-secretin adenoma, metastases, adrenal carcinoma, and myelolipoma. Lesions such as cysts, inflammatory or infectious lesions, bilateral adrenal bleeding or, as in the case reported here, ganglioneuroma are less frequently found. Our clinical case was a 61-year-old with a history of pemphigus vulgaris in 1998 who required high-dose corticosteroid therapy. She reported no known allergic reactions to drugs, and had no history of high blood pressure, diabetes mellitus, or dyslipidemia. A computed tomography (CT) scan of the chest performed for chronic cough revealed a left adrenal mass 61 mm × 47 mm × 37 mm in size with lobulated contours and attenuation values of 20--30 Hounsfield units (HUs) in basal slices (Fig. 1; oral and intravenous contrast was not used because the radiologist suspected pheochromocytoma based on basal images). The patient was referred to the endocrinology department to work-up a left adrenal incidentaloma. The patient reported pain at rest in the left lumbar region. Upon specific questioning, she reported no constitutional symptoms or evidence of hypercortisolism (central obesity, striae, muscle weakness, bruising, mood changes, hirsutism, acne), hyperandrogenism, or hyperaldosteronism (HBP, muscle weakness, nocturia, urinary