MON-486 - A Case Report: When the Adrenals Heal Themselves: A Case of Spontaneous Structural and Functional Recovery

Bilateral adrenal nodules associated with primary adrenal insufficiency are uncommon, and spontaneous resolution of both structural and functional abnormalities is exceedingly rare. We describe a 73-year-old patient who presented with new-onset primary adrenal insufficiency, confirmed by a suboptimal cortisol response to cosyntropin stimulation (peak cortisol 2.3 µg/dL) and undetectable plasma aldosterone levels. Glucocorticoid and mineralocorticoid replacement therapy was initiated, resulting in clinical stabilization. Cross-sectional imaging identified bilateral adrenal nodules (right: 2.8 cm, 23 Hounsfield units [HU], 50% contrast washout; indeterminate lesion; left: 3.7 cm, 38 HU, 70% washout), with imaging characteristics suggestive of lipid-rich adrenal adenomas. An extensive etiologic evaluation, including urine fungal antigens, QuantiFERON-TB assay, HIV testing, and 21-hydroxylase autoantibodies, was unrevealing.

On one-year follow-up with PET–CT, both adrenal nodules demonstrated complete radiologic resolution with restoration of normal adrenal morphology. Glucocorticoid and mineralocorticoid replacement therapy (hydrocortisone and fludrocortisone) was progressively tapered and ultimately discontinued. The patient remained clinically asymptomatic and normotensive, with an appropriate cortisol response, indicating full recovery of adrenal function. This case illustrates a rare reversible adrenal pathology and emphasizes the potential for adrenal functional recovery, highlighting the importance of long-term follow-up prior to establishing a diagnosis of permanent adrenal insufficiency.

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