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Adrenal Histoplasmosis

Vanessa Sanders1, Joseph Donald, Barry A Siegel

  • 1From the Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO.

Clinical Nuclear Medicine
|May 16, 2018
PubMed

Insights

This study reports a case of an elderly woman with seizure and hyponatremia. Imaging revealed adrenal gland enlargement and pulmonary nodules, with intense F-FDG uptake in the adrenals, suggesting potential malignancy or infection.

Area of Science:

  • Endocrinology
  • Oncology
  • Nuclear Medicine

Background:

  • Adrenal gland enlargement can present with diverse clinical manifestations, including seizures and electrolyte imbalances like hyponatremia.
  • Metastatic disease and primary adrenal pathologies require accurate diagnostic evaluation.

Observation:

  • An 89-year-old female presented with seizure and hyponatremia.
  • Computed tomography (CT) and magnetic resonance imaging (MRI) revealed bilateral adrenal gland mass-like enlargement and multiple pulmonary nodules.
  • Positron emission tomography/computed tomography (PET/CT) showed intense Fluorodeoxyglucose (F-FDG) uptake in the enlarged adrenal glands.

Findings:

  • The intense F-FDG uptake in the adrenal glands, contrasted with mild uptake in pulmonary nodules, broadened the differential diagnosis.
  • Key considerations included adrenal lymphoma, granulomatous infections, and metastatic lung cancer.

Implications:

  • This case highlights the importance of integrated imaging modalities like PET/CT in evaluating adrenal masses.
  • Distinguishing between infectious, neoplastic, and metastatic causes of adrenal enlargement is crucial for appropriate patient management.
  • Further investigation is warranted to determine the definitive etiology of the adrenal and pulmonary findings.

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