Functional Adrenal Collision Tumor in a Patient with Cushing's Syndrome

Area of Science:

• Endocrinology
• Oncology
• Pathology

Background:

• Adrenal collision tumors, a rare entity, pose diagnostic difficulties.
• Myelolipomas are benign adrenal tumors containing mature adipose tissue and hematopoietic elements.
• Cushing's syndrome is characterized by excessive cortisol production.

Observation:

• A 45-year-old woman with obesity and diabetes mellitus presented with an incidentally discovered adrenal mass.
• Initial imaging suggested a myelolipoma due to the presence of macroscopic fat.
• Functional workup revealed adrenocorticotropic hormone- (ACTH-) independent Cushing's syndrome.

Findings:

• The adrenal mass was pathologically confirmed as a collision tumor comprising an adrenocortical adenoma and a myelolipoma.
• Laparoscopic adrenalectomy was performed successfully.
• Postoperative improvement in clinical symptoms, body mass index, and hemoglobin A1C was observed.

Implications:

• Clinicians should consider functional evaluation for adrenal masses with features suggestive of myelolipoma.
• Hormonally active collision tumors can mimic benign conditions, necessitating thorough investigation.
• Early diagnosis and treatment of adrenal collision tumors can lead to significant clinical improvement.