World Journal of Endocrine Surgery

Register      Login

VOLUME 12 , ISSUE 1 ( January-April, 2020 ) > List of Articles


Surgery for Symptomatic Bilateral Giant Adrenal Cyst: Functional Preservation vs Oncological Appropriateness

Michele N Minuto, Francesca Rosa, Fiammetta Sertorio, Gian L Ansaldo, Giuseppe Cittadini, Beatrice Damasio, Gian M Magnano

Citation Information : Minuto MN, Rosa F, Sertorio F, Ansaldo GL, Cittadini G, Damasio B, Magnano GM. Surgery for Symptomatic Bilateral Giant Adrenal Cyst: Functional Preservation vs Oncological Appropriateness. World J Endoc Surg 2020; 12 (1):34-37.

DOI: 10.5005/jp-journals-10002-1279

License: CC BY-NC 4.0

Published Online: 30-10-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Background: Adrenal cysts are uncommon and generally asymptomatic, thus often discovered only incidentally. In the case described here, two giant bilateral adrenal cysts were diagnosed in an emergency setting based on the onset of acute compressive symptoms. Only after a complete diagnostic workup aimed at excluding any suspicion of malignancy, the patient underwent elective and adrenal-preserving surgery. Case description: A 26-year-old man was hospitalized in the emergency room for abdominal pain and dyspepsia. The ultrasound (US) scan showed two giant masses of both the adrenals. The workup allowed a diagnosis of nonfunctioning giant adrenal cysts, one with evidence of intracystic bleeding. Bilateral surgery was indicated and, on both sides, a wide resection of the cyst wall was performed laparoscopically, trying to preserve the adrenal function. At follow-up, the patient shows no evidence of recurrent disease. Conclusion: Despite an acute onset of compressive symptoms that led the patient to hospitalization in an emergency setting, the symptoms of the patient were cured at first. A correct and thorough subsequent workup was then performed that allowed to make a diagnosis of bilateral giant adrenal cysts without any sign of malignancy. This diagnosis indicated a bilateral adrenal-sparing decompressive procedure that, after follow-up, resulted in long-term cure. Clinical significance: A correct imaging played a key role in planning the treatment since it could exclude any suspicion of malignancy, thus allowing to indicate a “functional” approach aimed at avoiding a lifelong and difficult-to-manage substitutive therapy in a young patient.

  1. Farrugia FA, Martikos G, Surgeon C, et al. Radiology of the adrenal incidentalomas. Review of the literature. Endocr Regul 2017;51(1): 35–51. DOI: 10.1515/enr-2017-0005.
  2. Bellantone R, Ferrante A, Raffaelli M, et al. Adrenal cystic lesions: report of 12 surgically treated cases and review of the literature. J Endocrinol Invest 1998;21(2):109–114. DOI: 10.1007/BF03350324.
  3. Neri LM, Nance FC. Management of adrenal cysts. Am J Surg 1999;65(2):151–163.
  4. Tagge DU, Baron PL. Giant adrenal cyst: management and review of the literature. Am Surg 1997;63(8):744–746.
  5. Poiana C, Carsote M, Chirita C, et al. Giant adrenal cyst: case study. J Med Life 2010;3(3):308–313.
  6. Sivasankar A, Jeswanth S, Johnson MA, et al. Acute haemorrhage into adrenal pseudocyst presenting with shock: diagnostic dilemmas-report of three cases and review of literature. Sci World J 2006;19(6):2381–2387. DOI: 10.1100/tsw.2006.369.
  7. Ricci Z, Chernyak V, Hsu K, et al. Adrenal cysts: natural history by long-term imaging follow-up. Am J Roentgenol 2013;201(5):1009–1016. DOI: 10.2214/AJR.12.9202.
  8. Kirks DR, Merten DF, Grossman H, et al. Diagnostic imaging of pediatric abdominal masses: an overview. Radiol Clin North Am 1981;19(3):527–545.
  9. Khan MR, Ajmal S, Saleem T. Giant adrenal endothelial cyst associated with acute and chronic morbidity in a young female: a case report. Cases J 2009;9(2):8841. DOI: 10.4076/1757-1626-2-8841.
  10. Singh N, George RK, Gupta SK, et al. Giant adrenal cyst presenting as a diagnostic dilemma: a case report. Int Surg J 2005;90(2):78–80.
  11. Inan M, Besim H, Tulay S, et al. Giant symptomatic adrenal cyst in a patient with an ectopic kidney. Can J Surg 2009;52(2):25–26.
  12. De Toma G, Gabriele R, Plocco M, et al. Adrenal cysts: therapeutic indication. Minerva Chir 1995;50(10):925–928.
  13. Scully RE, Mark EJ, McNeely WF, et al. Case records of the Massachusetts general hospital: weekly clinicopathological exercises, case 15-1992. A 23-year-old woman with a painful mass in the right adrenal region. N Engl J Med 1992;326(15):1008–1015. DOI: 10.1056/NEJM199204093261508.
  14. Stimac G, Katusic J, Sucic M, et al. A giant haemorrhagic adrenal pseudocyst: Case report. Med Princ Pract 2008;17(5):419–421. DOI: 10.1159/000141509.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.