Enlarging hypermetabolic nodule: benign non-functional adrenocortical adenoma.

Hannah-Shmouni F, et al. BMJ Case Rep 2017. doi:10.1136/bcr-2017-220820 Description A 70-year-old woman with controlled type 2 diabetes mellitus and hypertension presented for evaluation of chronic abdominal discomfort. An incidental 3.2×3.5×3 cm left adrenal mass was identified on CT. Physical examination revealed obesity stage 2 without a Cushingoid appearance and controlled hypertension with a regular heart rate. Biochemical evaluations for Cushing syndrome, primary aldosteronism and pheochromocytoma were negative. A 1-year follow-up CT of the adrenal glands with washout showed a larger left-sided adrenal mass, measuring 4.3x3.4x3 cm (figure 1A). The attenuation values of the mass were indeterminate: non-contrast, 15 Hounsfield unit (HU); portal venous, 70 HU; delayed, 42 HU; absolute washout, 51%. MRI of the abdomen confirmed the left adrenal mass (figure 1B,C). Given the rapidly increasing size, malignancy was suspected and a whole-body positron emission tomography/CT scan using 18F-fluorodeoxyglucose (18F-FDG) was performed, which demonstrated (figure 1D,E) an 18F-FDG avid adrenal