PMC5291089_01
(A) CT abdomen with evidence of intra-peritoneal gas, black arrow: adenoma
within the right adrenal, red arrow: enlarged left adrenal. (B) Octreotide scan
demonstrating physiological uptake in the left adrenal, black arrows: increased
uptake in the right adrenal. (C) Right adrenal specimen, weight 17g, black
arrow: 14mm well-circumscribed phaeochromocytoma with central cystic
degeneration. (D) Right adrenal, demonstrating cytoplasmic positivity for
chromogranin A. (E) Left adrenal, cortical hyperplasia, weight 33g. (F) Left
adrenal, infiltration of eosinophilic cell characteristic of hyperplasia.
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fig1
The left adrenal was enlarged measuring 20x33x34mm with attenuation values over 50 Hounsfield units (Fig. 1A). However, the patient developed sudden, severe abdominal pain with radiological evidence of intra-abdominal gas (Fig. 1A), requiring cancellation of the high-dose DST. To ensure that other ectopic ACTH sources were excluded and to consolidate our view about an adrenal source, an octreotide scan was performed showing focal uptake in the right adrenal (Fig. 1B), supporting suspicions of a right adrenal pathology. There was physiological uptake in the left adrenal (Fig. 1B).