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Introduction: Adrenal Incidentalomas (AI) are increasingly found with recent proliferation in imaging techniques. The precise prevalence of AI is not well established but estimated to be about 5%. Such findings require thorough work and follow up plans to assess for hormonal functionality and differentiate between benign or a malignant entity. Adrenocortical carcinoma (AC), schwannoma (SCH), ganglioneuroma (GN), myelolipoma (ML), neuroblastoma (NB), and ganglioneuroblastoma (GNB) are a rare presentation of AIs. In this case series, we present 2 cases of uncommon AIs. Cases Series: Case 1: A 55-year-old man presented to the hospital with episodic dizziness, nausea, vomiting, and diaphoresis. His physical examination and blood workup were unremarkable. He takes multiple antihypertensive medications at home. CT abdomen revealed an incidental 5 cm mass adjacent to the left adrenal gland which was confirmed to be of adrenal origin on MRI. The hormonal workup was negative. and patient. Laparoscopic left adrenalectomy was performed. Histopathological diagnosis pointed to a benign nerve sheath tumor. Tumor cells stained positive for S-100 and negative for CD34 and epithelial membrane antigen. The morphologic features and immunohistochemical profile consistent with adrenal SCH diagnoses, confirmed by two histopathologists. Postoperatively, Blood pressure improved, and the patient has no evidence of recurrence on subsequent follow-ups. Case 2: A 38-year-old female presented to the hospital with severe right groin pain. During the workup, a CT abdomen revealed a homogeneous, lobulated, minimally enhanced, 5.8 cm right adrenal mass with no calcifications. The hormonal workup was negative. FDG-PET scan showed low uptake in the right adrenal mass. Adrenalectomy was performed and histological examination revealed Schwan cells and neurites with occasional ganglion cells compatible with benign GN. Discussion: SCHs originate from Schwann cells in peripheral nerve sheaths. Adrenal SCHs are rare, they represent about 0.5% of all SCHs. Surgical resection is the initial management as imagings are non-diagnostic and appearance does not distinguish benign from malignant lesions. Adrenal GNs originate from neural crest cells in the adrenal medulla and represents between 20–30% of all GNs. They may be primary or evolve from differentiating NB. The majority of them are sporadic. GNs are typically benign and asymptomatic. However, larger GNs are associated with an increased risk of malignancy, a 33% risk for 5 cm compared to 92% for 6 cm. Surgical resection is necessary, especially for larger masses. Conclusion: Besides the common adrenal incidentalomas and their proper work and follow up plans, a clinician should consider atypical adrenal tumors with unusual presentation. Surgical treatment and histological examination are essential for an accurate diagnosis.

The USDA Dietary Guidelines recommend consumption of 3 servings of low/non-fat dairy per day. However, the effect of higher consumption and fat content in type 2 diabetes (T2D) is unknown. This study evaluates the impact of higher consumption of full-fat (FF) and low-fat (LF) dairy on A1C and cardiovascular risk factors in patients with T2D. We enrolled 111 patients with uncontrolled T2D (age 58.5±8.9 years, 46.8% female) who were consuming <3 servings of dairy/day and randomized them into 3 groups: control group maintained baseline dairy intake, LF group incorporated ≥3 servings of LF dairy/day, and FF group incorporated ≥3 servings of FF dairy/day. Participants were counseled by a registered dietitian to maintain their daily caloric intake and body weight. Patients maintained their diabetes, antihypertensive, and lipid lowering medications during the study. Participants were evaluated at baseline, 3 months, and 6 months. At baseline, T2D duration was 13.2±8.3 years, A1C 8.1±0.97%, body weight 93.3±18.9 Kg, BMI 32.47±5.68 Kg/m2, daily caloric intake 1925±553 kcal (43.4±7.0% carbohydrates, 37.8±5.5% total fat, 13.1±2.9% saturated fat, and 18.2±3.7% protein), LDL-C 84.3±27.4 mg/dL, TG 163.5±154.8 mg/dL, systolic BP 130±16 mmHg, and diastolic BP 71±9 mmHg. There were no differences between groups at baseline except for higher HOMA-IR in the FF group. At 6 months, % calories from saturated fat increased by 3.6% from baseline in the FF group (p<0.0001) and decreased by 1.9% in the LF group (p<0.05). The % calories from protein increased by 4.5% in the LF group (p<0.0001), but did not change in the FF group. There were no differences in total caloric intake, % calories from carbohydrates or protein, A1C, BMI, body weight, lipid parameters, or BP between the 3 groups. Conclusion: When on isocaloric diet, increasing consumption of dairy to ≥3 servings/day has similar impact on A1C, lipid profile and BP in patients with T2D, irrespective of fat content. Disclosure J. Mitri: Research Support; Spouse/Partner; AbbVie Inc., Janssen Pharmaceuticals, Inc. Research Support; Self; Kowa Pharmaceutical Europe Co. Ltd., National Dairy Council. Research Support; Spouse/Partner; Takeda Pharmaceutical Company Limited. Other Relationship; Self; National Dairy Council. S. Tomah: Stock/Shareholder; Self; Amarin Corporation. A. Mottalib: None. V. Salsberg: None. S. Ashrafzadeh: None. T. Elseaidy: None. A. Al Maradni: None. K. Alsibai: None. A.H. Eldib: None. M. Tasabehji: None. D.M. Pober: None. O. Hamdy: Advisory Panel; Self; AstraZeneca, Sanofi-Aventis. Consultant; Self; Abbott, Merck & Co., Inc. Research Support; Self; National Dairy Council. Stock/Shareholder; Self; Healthimation, LLC. Funding National Dairy Council

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