A 16-year-old girl presented with a 5-month history of right loin pain. Imaging studies revealed a large right adrenal mass. Laboratory tests were suggestive of a nonfunctioning right adrenal tumor. She underwent a laparoscopic right adrenalectomy to remove the mass. Histopathology of the surgical specimen confirmed an adrenal cortical adenoma. The patient had an uneventful postoperative recovery.

1. Presented by-
Dr. Sharif Md. Shahadat Ali Khan
Orange unit, Department of Urology
National Institute of Kidney Diseases & Urology
A 16 year old girl
with right loin pain

2.  Ms. Shampa 16 years old non-diabetic,
normotensive, non asthmatic student from
Faridpur
 Pain in right loin for 5 months
 Pain was dull aching, non radiating,
moderate in intensity, initially intermittent
but for the last 2 months it became
constant .

3.  No particular aggravating factor but relieved
after taking analgesics.
 No history of fever, haematuria, calcuria,
pyuria, anorexia, nausea, vomiting, weight
loss, cough, haemoptysis, chest pain, bone
pain, jaundice, haematemesis or melaena.
 Her bowel habit was normal.

4.  General examintaion findings were normal & all
the vital parameters were within normal range.
 Abdominal & genitourinary examination
revealed no abnormality.
 Other systemic examination revealed normal
findings.

6.  Right Hydronephrosis
 Right renal stone
 Right upper ureteric stone
 Right renal mass
 Right adrenal mass

8.  Both kidneys are normal in size, shape & position
with well defined cortex & medulla.
 No calculus or any sign of ureteric obstruction is
seen.
 A large soft tissue mass (9.5 X 8 cm) with well
demarcated margin is seen in right
hypochondrium antero-superior to upper pole of
right kidney.

10. Urine for Routine & Microscopic Examination :
 Pus cells : 1-2/HPF
 Epithelial cells : 0-2/HPF
 RBC : Nil
 Cast : Nil
Urine C/S: No Growth.
S Creatinine : 0.73 mg/dl

11. CT Urogram

15.  A large (8.5X7.1cm) well defined soft tissue
mass is noted in right adrenal, compressing &
depressing rt kidney downward & posteriorly.
 Diagnosis: Suggestive of Rt adrenal mass.

17.  24 hrs urinary VMA: 4.87 mg/24hrs (<13.60)
 Serum cortisol : 10µg/dL (5-20µg/dL)

18.  Complete Blood Count :
Hb level 13.8gm/dl
ESR 20mm in 1st hour
Total count
Differential
Count
RBC 4.2 million/c.mm
WBC 8600 /c.mm
Platelet 3,00,000/c.mm
Neutrophil 56%
Lymphocyte 38%
Monocyte 02%
Eosinophil 04%
Basophil 00%

19. Right nonfunctioning adrenal mass

20. Laparoscopic right
adrenalectomy

21. Date :10.07.2018
N/O : Laparoscopic right adrenalectomy
Anesthesia : G/A
Findings & procedure:
 Modified lateral position angled at 60
degrees.
 Kocher maneuver was performed to
mobilize the second part of the
duodenum. Which permited the
visualization of the inferior vena cava.

22.  Right adrenal vein was carefully isolated,
clipped and divided.
 Adrenal arterial supply was divided by
thunderbeat.
 Specimen was removed by extending
camera port.

26.  Vital parameters were stable during
perioperative period.
 Postopertive recovery was uneventful