Incidental Adrenal Hemangioma: A Diagnostic and Management Challenge

Adrenal hemangioma is a rare, benign vascular tumor often discovered incidentally during imaging. Here, we present the case of a 43-year-old male individual who was incidentally found to have a right adrenal mass during evaluation for polycythemia. Initial imaging revealed a 3.1 × 2.3 cm mass. The unenhanced computed tomography (CT) attenuation was 31 Hounsfield units (HU), and the post-contrast attenuation was approximately 61 HU. Hormonal evaluations, including cortisol, dehydroepiandrosterone sulfate (DHEA-S), aldosterone, renin, and metanephrines, were all within normal limits. The patient was managed conservatively, with close follow-up. Over the course of 2 years, the lesion remained stable in size until a sudden increase was noted, reaching 4.3 × 3.3 cm, with magnetic resonance imaging (MRI) revealing necrotic areas and peripheral enhancement. Due to the lesion's rapid growth and indeterminate features, the patient underwent a laparoscopic right adrenalectomy. The histopathological analysis confirmed the diagnosis of a cavernous adrenal hemangioma. This case emphasizes the importance of recognizing adrenal hemangiomas, as they can mimic more aggressive adrenal tumors and require careful monitoring.