Macronodular adrenal hyperplasia masquerading as an upper pole renal mass

Area of Science:

• Endocrinology
• Urology
• Surgical Pathology

Background:

• Macronodular adrenal hyperplasia (MAH) is a rare endocrine disorder.
• MAH typically presents with Cushing Syndrome, but can be asymptomatic.
• Adrenal masses can be mistaken for renal tumors on imaging.

Observation:

• A patient presented with an adrenal tumor that appeared as an upper pole renal mass.
• The adrenal lesion was initially misdiagnosed as a renal tumor due to its location and appearance.
• The patient was asymptomatic, complicating the initial diagnosis.

Findings:

• The patient was diagnosed with combined macro- and micro-nodular adrenal hyperplasia.
• Imaging characteristics mimicked a renal mass, leading to a diagnostic challenge.
• Surgical intervention was required for definitive management.

Implications:

• This case underscores the importance of considering adrenal pathology in the differential diagnosis of upper abdominal masses.
• Accurate preoperative diagnosis is crucial to avoid unnecessary or incorrect surgical procedures.
• Robotic partial nephrectomy and adrenalectomy can be performed safely for complex adrenal and renal lesions.