Bilateral adrenal tumors of different type in an infant: A case report

Introduction: Bilateral primary adrenal tumors are rare, and the majority of cases present the same histology. Bilateral adrenal tumors with different histology are extremely uncommon. Case presentation: A 6-month-old male presented with abdominal distension and excessive crying. Physical examination revealed a blood pressure (BP) of 108/80 mmHg, centripetal obesity, a "full moon" facial appearance, mild abdominal distension, tenderness to palpation, and no palpable masses. Bilateral adrenal tumors were found ultrasound. Contrast-enhanced computed tomography (CT) showed a soft tissue mass of 3.2 cm in diameter in the right adrenal gland and a mass of 2.1 cm in diameter in the left adrenal gland. Serum cortisol was 1563 nmol/L (normal: 96-551 nmol/L). After ruling out distant metastases, the patient underwent a right-sided adrenalectomy and a left adrenal tumor enucleation to preserve as much normal tissue as possible on the left adrenal gland. Pathology revealed a right adrenal cortical carcinoma and left adrenal poorly differenciated neuroblastoma. Post-surgery, the patient received hydrocortisone supplementation as needed and neuroblastoma-targeted chemotherapy. Hydrocortisone replacement was progressively reduced and eventually weaned off. No recurring lesions have been detected at 1 year of follow-up period. Conclusion: Bilateral adrenal tumors should never be assumed to be of similar type because, while extremely rare, bilateral tumors of different types are possible. All efforts should be made to preserve the normal adrenal tissue in cases of bilateral adrenal masses.