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Peer-reviewedCC BY-NC-ND 4.0AACE Endocrinology and Diabetes

A Diagnostic Conundrum: A Hemorrhagic Adrenal Mass With Discordant Radiological, Biochemical, and Pathologic Features

  • Rahul Atodaria1
  • Layla Abdul Jabbar1
  • Jhonatan Rivera-Mora2
  • Dinh Quoc Duong3
  • Randa Abdelmasih2
  1. 1Department of Internal Medicine, University of Texas Medical Branch Galveston, Texas
  2. 2Division of Endocrinology, Department of Internal Medicine, University of Texas Medical Branch Galveston, Texas
  3. 3Department of Pathology, University of Texas Medical Branch Galveston, Texas
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Abstract

Background: Adrenal incidentalomas vary in their identity, making accurate diagnosis essential for management. Interpretation of these lesions using radiology, biochemistry, or pathology can be confounded by hemorrhagic changes, medication effects, and limitations of imaging. To prevent misclassification, an integrated assessment is crucial.

Case Report: We present a case of a 71-year-old male with an incidentally discovered left adrenal mass that exhibited computed tomography and MRI imaging findings concerning for pheochromocytoma or adrenal malignancy.

Discussion: Biochemical analysis ruled out pheochromocytoma and was suggestive of possible glucocorticoid and mineralocorticoid co-secretion, although clinical urgency of surgical resection precluded completion of confirmatory endocrinologic testing. The lesion was initially diagnosed as a benign endothelial adrenal cyst on pathologic review. Because of the discordance among the radiological, biochemical, and initial pathologic findings, an integrated histologic re-evaluation was requested. The mass was ultimately reclassified as an adrenocortical adenoma with extensive hemorrhagic and cystic changes.

Conclusion: This case highlights the importance of multidisciplinary integration when evaluating adrenal lesions with confounding features and underscores how suggestive (though incomplete) biochemical evidence can appropriately drive pathological re-evaluation.

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Cite

BibTeXRIS
BibTeX
@article{atodaria2026diagnostic,
  title = {{A Diagnostic Conundrum: A Hemorrhagic Adrenal Mass With Discordant Radiological, Biochemical, and Pathologic Features}},
  author = {Rahul Atodaria and Layla Abdul Jabbar and Jhonatan Rivera-Mora and Dinh Quoc Duong and Randa Abdelmasih},
  journal = {AACE Endocrinology and Diabetes},
  year = {2026},
  month = jul,
  doi = {10.1016/j.aed.2026.07.001},
  url = {https://doi.org/10.1016/j.aed.2026.07.001},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - A Diagnostic Conundrum: A Hemorrhagic Adrenal Mass With Discordant Radiological, Biochemical, and Pathologic Features
AU  - Rahul Atodaria
AU  - Layla Abdul Jabbar
AU  - Jhonatan Rivera-Mora
AU  - Dinh Quoc Duong
AU  - Randa Abdelmasih
PY  - 2026
DA  - 2026/07/07
JO  - AACE Endocrinology and Diabetes
DO  - 10.1016/j.aed.2026.07.001
UR  - https://doi.org/10.1016/j.aed.2026.07.001
AB  - Background: Adrenal incidentalomas vary in their identity, making accurate diagnosis essential for management. Interpretation of these lesions using radiology, biochemistry, or pathology can be confounded by hemorrhagic changes, medication effects, and limitations of imaging. To prevent misclassification, an integrated assessment is crucial.  Case Report: We present a case of a 71-year-old male with an incidentally discovered left adrenal mass that exhibited computed tomography and MRI imaging findings concerning for pheochromocytoma or adrenal malignancy.  Discussion: Biochemical analysis ruled out pheochromocytoma and was suggestive of possible glucocorticoid and mineralocorticoid co-secretion, although clinical urgency of surgical resection precluded completion of confirmatory endocrinologic testing. The lesion was initially diagnosed as a benign endothelial adrenal cyst on pathologic review. Because of the discordance among the radiological, biochemical, and initial pathologic findings, an integrated histologic re-evaluation was requested. The mass was ultimately reclassified as an adrenocortical adenoma with extensive hemorrhagic and cystic changes.  Conclusion: This case highlights the importance of multidisciplinary integration when evaluating adrenal lesions with confounding features and underscores how suggestive (though incomplete) biochemical evidence can appropriately drive pathological re-evaluation.
SN  - 3050-9157
ER  -