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Clinical Images

Bilateral Adrenal Tumors in Congenital Adrenal Hyperplasia

Christina Capps, MD and T. Karl Hoskison, MD

January 17, 2018

A 37-year-old female with a history of salt-wasting congenital adrenal hyperplasia (CAH) presented with abdominal pain and fever. Home medications included fludrocortisone 0.1mg daily, hydrocortisone 20 mg each morning, and hydrocortisone 5 mg nightly. Vital signs showed fever and mild tachycardia. Physical exam findings included abdominal tenderness of the right lower quadrant.
Initial labs revealed sodium of 128 mmol/L, potassium of 3.7 mmol/L, and 17,000 white blood cells per microliter. CT of the abdomen revealed a 7.3 cm right ovarian abscess and bilateral adrenal masses (See Image 1). The right mass measured 6.9 cm, and the left 7.3 cm. The Hounsfield units were estimated at 40 units without contrast and 105 units with contrast. Pheochromocytoma was ruled out with a negative 24-hour urine VMA and metanephrines collection.

Bilateral Adrenal Tumors in Congenital Adrenal Hyperplasia_Image1_Molumby_edited copy_Final.jpg

What electrolyte abnormality may suggest insufficient treatment of salt-wasting CAH?
A. Hypokalemia
B. Hyponatremia
C. Hypernatremia
D. Hyperglycemia

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1. Wang J, et al. Adrenal tumors associated with inadequately treated congenital adrenal hyperplasia. Can J Urol. 2002 June; 9(3):1563-4.

About the authors:

Christina Capps is a third year Internal Medicine Resident at the University of Oklahoma School of Community Medicine in Tulsa, OK.

T. Karl Hoskison is an Associate Professor and Internal Medicine Faculty Attending at the University of Oklahoma School of Community Medicine in Tulsa, OK.