Case Study

Adrenal Adenocarcinoma in a 12 year old MN DSH

A 12-year-old NM DSH was presented for evaluation as a newly diagnosed diabetic showing weight loss and vomiting.

DX

Adrenal Adenocarcinoma

Sonographic Differential Diagnosis

Left adrenal gland mass.
Chronic interstitial nephrosis with renal dysplasia and cortical infarcts.
Undefined, hyperechoic nodular liver changes.
Prominent, irregular pancreas.

Image Interpretation

The right adrenal gland was uniform, egg shaped and hypoechoic measuring 0.9 x 0.45 cm. The left adrenal gland was enlarged and heterogenous measuring 1.26 x 1.2 cm. The left adrenal gland was primarily hypoechoic with nodular changes. There was no evidence of vascular invasion noted. This is consistent with primary adrenal gland neoplasia such as adenocarcinoma. Pheochromocytoma is less likely.

The right kidney was enlarged with loss of corticomedullary definition and measured 5.2 cm. The right kidney revealed an interstitial nephrosis pattern with potential for emerging lymphoma. However, given the prior sonogram results this is unlikely. Interstitial nephrosis and compensatory hypertrophy is likely. Minor pyelectasia was noted. The left kidney revealed significant dystrophic changes and thickened irregular cortices with cortical infarcts.

The liver was uniformly enlarged with occasional heterogenous isoechoic to hypoechoic and hyperechoic nodules. The left medial lobe revealed a hyperechoic nodule that measured 0.72 x 0.49 cm.

The pancreas was prominent and irregular.

Outcome

Sodium potassium ratio, full adrenal gland panel and blood pressure measurements are recommended. Given the diabetic status and the adrenal gland tumor the adrenal gland is likely related. If the urine specific gravity is less than 1.020 then LDDST would be recommended. Left adrenalectomy, renal biopsy and liver biopsy would all be ideal. No overt evidence of metastatic disease. However, technically the hepatic nodules could represent metastatic lesion that are more consistent with lipogranulomas given the global presentation. FNA are recommended. Blood pressure measurements are recommended. Pancreatitis may be playing a role in the diabetic status as well as the adrenal gland tumor.