Giant primary adrenal hydatid cyst presenting with arterial hypertension: a case report and review of the literature

Abstract

IntroductionA primary hydatid cyst of the adrenal gland is still an exceptional localization. The adrenal gland is an uncommon site even in Morocco, where echinococcal disease is endemic.Case presentationWe report the case of a 64-year-old Moroccan man who presented with the unusual symptom of arterial hypertension associated with left flank pain. Computed tomography showed a cystic mass of his left adrenal gland with daughter cysts filing the lesion (Type III). Despite his negative serology tests, the diagnosis of a hydatid cyst was confirmed on surgical examination. Our patient underwent surgical excision of his left adrenal gland with normalization of blood pressure. No recurrence has occurred after 36 months of follow-up.ConclusionThere are two remarkable characteristics of this case report; the first is the unusual location of the cyst, the second is the association of an adrenal hydatid cyst with arterial hypertension, which has rarely been reported in the literature.

Primary hydatid cyst in the adrenal gland

“…Diagnostic difficulties arise when HD occurs in unusual locations. Most hydatid cysts that arise within the adrenal gland are part of a disseminated disease; a primary adrenal hydatid cyst is extremely rare 7. The clinical presentation of abdominal HD is non-specific, and abdominal pain is the most common presenting symptom 8.…”

“…The clinical presentation of abdominal HD is non-specific, and abdominal pain is the most common presenting symptom 8. Most adrenal hydatid cysts are incidentally found during abdominal imaging for other abdominal pathologies 7. Arterial hypertension associated with adrenal HD is a rare presentation and may arise from external compression of the renal parenchyma, a state known as Page kidney 2 7 9–11…”

Leczenie laparoskopowe torbieli nadnerczy — materiał własny i przegląd piśmiennictwa

“…15% of cases. What is more, adrenal cysts accompany approximately 7% of primary and metastatic cancerous processes, and in 0.5% of cases they are of parasitic origin [4,6,12]. Hence, each surgical intervention should include an individual differential diagnosis.…”

“…5% of the examined population [2]. Cysts constitute 5.4% to 6.0% of all pathological changes affecting adrenal glands [3]. In about one-third of the cases, lesions are detected incidentally; in the remaining two-thirds cysts are symptomatic, which is typically related to their large size or rapid growth.…”

“…Echinococcal cysts are quite rare -their incidence is estimated at 0.5% of all adrenal pseudocysts. Still, due to possible outcomes and complications they require special care in surgical treatment and preceding diagnostics [6]. Cysts may coexist with primary and metastatic adrenal tumours.…”