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Rare disease
Management of adrenal incidentaloma: size still matters
  1. Jordan ST Bowen1,
  2. Andrew Parker2,
  3. Shubha S Bellur2,
  4. Bangalore Anilkumar3,
  5. David Dove4,
  6. Greg P Sadler5,
  7. Upendram Srinivas-Shankar6
  1. 1Oxford Deanery, Heatherwood and Wexham Park Hospital, Slough, Berkshire, UK
  2. 2Department of Pathology, John Radcliffe Hospital NHS Trust, Headington, Oxford, UK
  3. 3Department of Radiology, Heatherwood and Wexham Park Hospital, Slough, UK
  4. 4Department of Diabetes and Endocrinology, Heatherwood and Wexham Park Hospital, Slough, Berkshire, UK
  5. 5Department of Surgery, John Radcliffe Hospital NHS Trust, Headington, UK
  6. 6Department of Diabetes and Endocrinology, St Helens and Knowsley Teaching Hospitals NHS Trust, St Helens, UK
  1. Correspondence to Dr Upendram Srinivas-Shankar, usrinivas{at}


A 56-year-old man was found to have an adrenal incidentaloma on a CT scan of the abdomen. Clinically and biochemically, the mass was not functional. MRI scan revealed a heterogeneously enhancing, T2-hyperintense, right-sided adrenal mass (4.5×6.5 cm). Meta-iodo-benzylguanidine scan was normal, making a diagnosis of pheochromocytoma unlikely. As the mass was larger that 4 cm, it was excised and histopathological examination revealed a rare, composite tumour: benign adrenal adenoma with haemangiomatous and myelolipomatous components. This case highlights the difficulties encountered by a clinician faced with investigating a potentially malignant adrenal mass (based on size) and correlates radiological findings with a rare histopathological specimen.

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  • Competing interests None.

  • Patient consent Obtained.

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