Congenital adrenal hyperplasia

Case contributed by Henry Knipe

Presentation

Routine follow-up.

Patient Data

Age: 65 years
Gender: Female

Right adrenal mass 3 cm with a further anterior 1 cm nodule.

Lobulated left adrenal mass measuring 5 cm. Exophytic region of macroscopic fat superiorly.

Both demonstrate heterogeneous postcontrast enhancement. No calcifications. Non-nodular adrenal gland limbs are thickened. 

No upper abdominal lymphadenopathy.

Fatty liver. Large midline infra umbilical anterior abdominal wall hernia.

Case Discussion

This patient had a known history of congenital adrenal hyperplasia after presenting with Addison disease at birth. Her congenital adrenal hyperplasia had been poorly controlled with the patient lost to follow-up. The adrenal changes are typical with background adrenal limb thickening with numerous adrenal masses and nodules, some containing macroscopic fat - these likely represent a combination of nodular hyperplasia, adenomas and myelolipomas

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