Introduction Cyst adrenal lesions are uncommon with a reported incidence in autopsies of 0. 064% to 0.18%. Functional adrenal cysts are rarer, to our knowledge with 3 cases reported in the literature, 2 producing catecholamines and 1 producing aldosterone. Clinical case: A 39-year-old male patient with arterial hypertension since the age of 38 without target organ involvement or hydroelectrolytic alterations was taken to studies of secondary hypertension, as a positive finding we found aldosterone in 10.5 ng/dl (n <10 ng/dl) and direct renin 0. 0296 mU/L (n >1 mU/L) for an aldosterone-renin ratio of 354 (n <3.7); Confirmation of hyperaldosteronism was performed with a saline solution suppression test, with basal aldosterone of 14.4 ng/dl and post saline of 9.53 ng/dl. (n <5ng/dl). He was taken to localization studies with contrast-enhanced CT scan of the abdomen, finding a low-density left adrenal adenoma. A laparoscopic adrenalectomy was performed, on pathology an adrenal cyst was report without nodular lesions. 4 months later clinical and biochemical resolution was confirmed. Conclusion This patient is the 4th case published in the literature of a biochemically confirmed functional adrenal cyst, which is important in order not to rule out the presence of adrenal cysts as a possible etiology of hormone overproduction. Presentation: No date and time listed

Background we present a case of hypophysitis with gonadotropic and somatotropic axis compromise and adrenalitis secondary to the use of nivolumab and ipilimumab. Clinical Case A 74-year-old woman with a history of metastatic renal cell carcinoma treated with ipilimumab and nivolumab for 10 months, suspended treatment due to pneumonitis. Three months later, she consulted the emergency department due to limitations in daily activities, asthenia, and drowsiness. physical examination was unremarkable except for hypotension. Laboratory studies showed profound hyponatremia (106 mEq/l, n: 135 a 145 mEq/l), low serum osmolality (236 mmol/kg n: 275 - 295 mmol/kg) and a basal cortisol (5 μg/dL n: 3.7 - 19.4 μg/dL). Hypophysitis was suspected and a pituitary profile revealed low somatomedin C (25 ng/ml n: 54 204 ng/ml), FSH (20.6 UI/L n: 26.7 -133.4 UI/L), and strikingly elevated ACTH (91.9 pg/mL n: 4.7 - 48.5 pg/mL). Pituitary MRI had no structural anomaly. A diagnosis of hypophysitis and primary adrenal insufficiency secondary to adrenalitis due to the use of immunotherapy was made. The compromise of the gonadotropic and somatotropic axis with a normal image can occur in up to 23% of patients with this clinical entity. The patient had significant clinical improvement with glucocorticoid and mineralocorticoid replacement. Conclusions To our knowledge this is the first reported case of hypophysitis and adrenalitis secondary to immunotherapy. Hypophysitis has a prevalence up to 8% with the combination of ipilimumab plus nivolumab. It should be considered despite a normal pituitary MRI. However, adrenalitis associated with the use of these drugs has only been reported in 2.6% and the coexistence of both entities is even rarer Presentation: No date and time listed

Background Lymphocytic (LH) or autoimmune hypophysitis (AH) is a rare inflammatory disorder of the hypophyseal gland, often miss-diagnosed. LH is predominant in females, occasionally related with other rheumatic disorders (1-20%). The disease can lead to pituitary dysfunction and symptoms of hypopituitarism, the most affected axes are the ACTH and TSH. Definitive diagnosis of AH can be based only on pathological examination of a pituitary biopsy sample but such invasive procedure is seldom needed. Different imaging modalities, especially MRI, can be useful but up to 30% can be unremarkable, thus clinical manifestations and biochemical evaluation is of great importance in guiding the diagnosis. Hormonal replacement therapy is the main treatment strategy. Immunosuppressive drugs are indicated by the severity of the symptoms and the underlying autoimmune disease. Clinical Case A 36 year old patient with active lupus and Sjogren disease presented to the emergency department with syncope and hypotension preceded by a 6 month history of intense fatigue. She did not take any steroids in the 6 months prior. Initial tests were consistent with secondary adrenal insufficiency; low plasma cortisol (<1ug/dl n 5-23 ug/dl) and ACTH-concentrations below detection (< 4 ng/l), central hypothyroidism; abnormal low TSH (0. 04uU/ml n 0.4-4.5 uU/ml) and low free T4 (0.56 ng/dl n 0.8-2 ng/dl), and growth hormone deficiency (IGF1 below age and sex normal values). Craneal CT and pituitary MRI didn't show any anomaly. Based on symptoms, clinical context and test results the pressumtive diagnosis was AH related to her lupus. The patient was treated with hydrocortisone and levothyroxine with excellent response and complete resolution of her symptoms. Clinical Lesson: This case demonstrates that hypophysitis is a clinical entity that can be suspected and treated based on clinical and past medical history even in the context of normal imaging were an invasive procedure such as a biopsy would likely not change the final outcome. Presentation: No date and time listed