Insights into diagnosis and management of giant adrenal pseudocysts

Adrenal cysts are rare lesions that may coexist with, or mimic, malignant adrenal tumours. Their shared imaging characteristics may cause misdiagnosis with potentially harmful outcomes. We report the case of a young man who presented with several months of headaches and mild anaemia. Non-contrast CT imaging revealed a giant left adrenal cystic lesion measuring 19×15×15 cm with indeterminate CT attenuation and internal debris. 18 F-fluorodeoxyglucose-positron emission tomography demonstrated low peripheral uptake favouring a benign aetiology. The multidisciplinary recommendation was for excision given the lesion size, mass effect and risk of rupture. Open adrenalectomy confirmed a benign pseudocyst. This case demonstrates the diagnostic challenges posed by giant adrenal pseudocysts and highlights the importance of multimodality imaging and multidisciplinary input to prevent misdiagnosis and ensure appropriate management.