Figure 3 MRI and PET/CT findings suggestive of ectopic adrenal gland. A: MRI T2-weighted images show a 3.6×2.6 cm Tumor within the left renal sinus with fat signal. B : The enhancement scan reveals uniform enhancement in the parenchymal portion. The Tumour contains the left renal lower pole artery traversing it, and the Tumor is closely related to the renal vein. C : PET/CT: A round, isodense, mixed-density Tumor is observed in the left renal hilum. D : Both 18-FDG and 18F-PSMA PET/CT imaging show increased radioactive uptake, with a maximum standardized uptake value (SUVmax) of 6.6(SUVmax < 2.5: Typically indicative of benign lesions or normal tissue. SUVmax > 2.5: Suggests the possibility of malignancy, requiring further evaluation in conjunction with the clinical context. SUVmax > 10: Commonly observed in highly metabolically active malignant tumors, such as lymphoma or lung cancer.),. No significant abnormal findings were noted in other areas.
Laboratory results: Increased cortisol secretion and disrupted diurnal rhythm were observed, with elevated 24-hour urinary free cortisol(24h-UFC) (Table 1). ACTH level was 4.43 pg/ml, and levels of angiotensin, renin, aldosterone, and aldosterone-to-renin ratio (ARR) were within the normal range.. Overnight 1 mg low-dose dexamethasone suppression test and 5 mg high-dose dexamethasone suppression test showed no suppression of cortisol levels. Liver and renal function tests, electrolytes, and blood glucose levels were all normal.