Pediatric adrenal incidentaloma

Adrenal incidentalomas are a rare finding in children. In adults, adrenal incidentalomas are often found during imaging or postmortem. When incidentally discovered in adults, the principles of management focus on estimating risk of malignancy, with subsequent treatment plans developed accordingly. Unfortunately, these guidelines are not applicable to children due to the difficulty in differentiating benign and malignant adrenal masses on imaging. For this reason, most pediatric adrenal masses are surgically excised. We present the case of a 14-year-old male who had imaging for nonspecific abdominal pain and was found to have a left-sided retroperitoneal mass suspicious for a retroperitoneal teratoma. Given the proximity to the adrenal gland, a hormonal workup was nonetheless performed with no evidence of abnormal hormonal activity noted. During laparoscopic intervention, this lesion was found to be originating from the adrenal gland raising suspicion for an adrenal mass and a laparoscopic left adrenalectomy was performed. Histology of the mass revealed a heterogenous mass with components concerning for adrenal cortical adenoma, myelolipoma and adrenocortical carcinoma. A more in-depth analysis of the mass using expert opinion revealed a diagnosis of adrenal cortical adenoma with hyaline myxoid stroma and secondary involutional features. •Adrenal incidentalomas are extremely rare in the pediatric population as opposed to adults.•All adrenal masses in children should be urgently evaluated due to high malignant risk.•Surgical resection of adrenal masses can be curative, but patients should have long term follow-up.