林柏宏、張英勛、馮思中、劉忠一、莊正鏗

林口長庚紀念醫院 外科部 泌尿科

Po-Hung Lin, Ying-Hsu Chang, See-Tong Pang, Chung-Yi Liu, Cheng-Keng Chuang

Divisions of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan

 

  A 67-years old woman presented to our outpatient department with a chief complaint of left adrenal tumor found after a traffic accident six months ago. There was no severe trauma in the traffic accident except multiple abrasion and contusion. She denied headache, palpitation, hypertension, sweating, or muscle weakness. There was no moon face, thin skin or buffalo hump. The lab data of VMA, aldosterone, renin, potassium and cortisol level were all within normal limit. The CT done after traffic accident revealed left adrenal mass 3.2 x 2.2cm with slight post-contrast enhancement. Non-functional adrenal incidentaloma was suspect and either surgical resection or follow up was suggested. The patient preferred follow up since there was no symptoms. The follow-up CT revealed gradually decreased size of left adrenal mass at 6 months and 12 months. CT at 48 months showed totally regression of left adrenal mass.

 

  There are two most important questions about the evaluation and treatment decision making of adrenal incidentaloma: Is the tumor malignant? Is the tumor functional? If the tumor size is more than 4 cm, malignancy should be considered. In this situation, surgical resection should be considered. If the tumor is functional with symptoms, such as primary aldosteronism, Cushing’s syndrome, or pheochromocytoma, surgical resection should also be considered. Otherswise, adrenal incidentaloma could be treated conservatively.

  In this patient, the adrenal tumor was found in the CT after traffic accident. There were no associated symptoms and nonfunctional incidentaloma was suspect. After two-year follow up the adrenal tumor disappeared completely. Therefore, it was assumed as hematoma related to trauma. However, adrenal trauma is usually accompanied with other related organ injury and indicated major trauma. Isolated adrenal trauma is rare and could be confused with adrenal tumor easily. History taking and different diagnosis are important to avoid unnecessary surgery.