Case Study

Adrenal mass in an 11 year old MN DSH with hind leg weakness, hyperglycemia and insulin resistence

An 11-year-old MN DSH was presented for hind leg weakness and the inability to use stairs. CBC was within normal limits. Abnormalities on blood chemistry were elevated albumin, hyperglycemia, hyperamylasemia, and hyperlipasemia. T-4 and free T-4 were both within normal range, and fructosamine was elevated. The patient was treated with increasing doses of Lantus with no effect on the hyperglycemia and the patient remained PU/PD. At the time of the ultrasound the Lantus dose was 9 units twice daily.

Sonographic Differential Diagnosis

Mineralizing right adrenal gland mass. The appearance of this mass is most suggestive for carcinoma.

Image Interpretation

The left adrenal gland was normal in size and contour. However, the right adrenal gland was mineralizing and this created a mass with expansion of the adrenal capsule and areas of mineralization. An intimate relationship with the caudal vena cava was noted, however, there was no overt invasion noted. This appears to be resectable. It is likely adenocarcinoma.

DX

Mineralizing right adrenal gland mass, suggestive for adenocarcinoma

Outcome

The patient was recommended for a three-view thoracic study, ACTH stimulation, blood pressure measurements, right adrenalectomy, and placement of a feeding tube. Thoracic radiographs showed no abnormalities. Surgery was discussed but due to the possibility of it not resolving the hyperglycemia, the insulin was changed to PZI instead. A glucose curve performed while the patient was on 6 units of PZI twice daily showed minimal change to the hyperglycemia. The dose was then increased to 7 units three times a day.