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.