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Jagat J. Mukherjee, Michael L. Villa, Lenny Tan, K. O. Lee, Bilateral Adrenal Masses Due to Histoplasmosis, The Journal of Clinical Endocrinology & Metabolism, Volume 90, Issue 12, 1 December 2005, Pages 6725–6726, https://doi.org/10.1210/jc.2005-1868
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A 40-YR-OLD diabetic, normotensive man presented with weight loss and epigastric discomfort for 6 months. Chest x-ray was normal. Computed tomography (CT) scan revealed bilateral adrenal masses (Fig. 1A). The second patient, a 58-yr-old hypertensive, nondiabetic man, presented with anorexia and weight loss for 5 months. Chest x-ray revealed mediastinal widening. CT scan showed aortic dissection without mediastinal lymphadenopathy and incidental bilateral adrenal masses (Fig. 1B).
Both patients had no history of tuberculosis; their HIV serology was negative. The 250-μg cosyntropin stimulation test was abnormal in the first patient (peak serum cortisol, 116 nmol/liter); he was commenced on hydrocortisone replacement. Urinary free catecholamine and metanephrine levels were normal in both. CT-guided fine needle aspiration cytology from the adrenal gland (Fig. 2) revealed features of histoplasma species in both; culture confirmed histoplasma capsulatum. They were treated with oral itraconazole (200 mg daily), the first patient for 15 months and the second for 6 months. Follow-up CT scans showed resolution of the adrenal masses in the first patient 5 yr later; he continues to have normal adrenal function at 9 yr. The adrenal masses have reduced in size in the second patient, but remain enlarged in the absence of any clinical disease at 18 months.
