Pigmented adrenocortical adenoma: a case report

Pigmented adrenocortical adenoma: a case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Pigmented adrenocortical adenoma: a case report hongzhi ye, Run-lin Feng, Dai-yan Wen, Hai-rong Wei, Xiang-meng Li, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4265988/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 3 You are reading this latest preprint version Abstract Pigmentary adrenal cortical adenoma is a special type of adrenal adenoma. The adenoma cells contain a large amount of lipofuscin or neuromelanin, which is brown-black in visual appearance. According to the reports of many cases, the incidence probability is not clear at present. Therefore, it is a topic worth exploring in terms of preferred treatment, pathological diagnosis and differentiation from other types of adrenal adenomas. Here we report a case of a nonfunctional pigmentary adrenocortical adenoma with a specific pathological pattern, the diagnosis of which depends on postoperative pathological examination and immunohistochemical examination. Surgical resection is the main treatment for this disease, most of the benign tumors have a good prognosis, and long-term postoperative follow-up should be carried out for potential malignant adrenal cortical adenomas. adrenal tumor pathological diagnosis immunohistochemistry Figures Figure 1 Figure 2 Figure 3 Figure 4 Case presentation The patient was a 55-year-old female, who was admitted to the urology ward of our hospital on April 6,2021 due to physical examination. The patient had no symptoms of headache, palpitations, sweating, blurred vision and vertigo. Physical examination: mild tenderness in the right renal area, blood pressure: 138 / 91mmHg, laboratory examination: angiotensin 226.71pg/ml, and the rest was normal (see Table 1 , Table 2 ). Imaging examination: renal artery CT spiral plain scan + enhancement + X-ray computerized layer imaging: the right adrenal gland saw circular space, clear boundary, equal density, size about 1.8cm*1.4cm, sees Fig. 1 A, enhanced scan showed mild progressive enhancement. The left adrenal gland had normal morphology, size, uniform density, no nodules or masses, and uniform enhancement after enhancement. ct in both renal arteries showed no significant abnormalities. B ultrasound suggests: in the right adrenal area, the boundary is still clear, and the size is about 2.0cm *1.6cm. Preliminary diagnosis is: the right adrenal gland occupancy, more consideration of adenoma. Table 1 Renin + angiotensin (Vertical position) abbreviation project name bear fruit unit reference ranges All Angiotensin measurement (lying position) 226.71 pg/ml 25–129 Renin Renin (lying position) 3.14 pg/ml 4–24 ALD Aldosterone assay(clinostatism) 94.37 pg/ml 10–160 aldosterone /Renin (lying) 30.05 All Angiotensin Measurement (Standing Position) 207.11 pg/ml 49–252 Renin Renin (standing position) 4.60 pg/ml 4–38 ALD Aldosterone assay(erect position) 106.69 pg/ml 40–310 aldosterone /Renin (standing) 23.19 Table 2 Circadian rhythm determination of plasma cortisol ACTH abbreviation project name bear fruit unit reference ranges ACTH Serum corticotropin measurement: (8:00) 1.73 pg/ml 7.2–63.4 ACTH Serum adrenocorticotropic hormone measurement: (16:00) 2.07 pg/ml ACTH Serum adrenocorticotropic hormone measurement: (24:00) 1.65 pg/ml Cor Plasma cortisol measurement (8:00) 14.76 ug/dl 4.62–24.85 Cor Plasma cortisol measurement (8:00) 13.86 ug/dl 2.9–17.3 Cor Plasma cortisol measurement (8:00) 14.06 ug/dl Treatment and pathological findings Treatment: α -blocker was treated for 2 weeks before surgery, 1500ml intravenous drip crystals and colloidal fluid were given 3 days before surgery, and laparoscopic retroperitoneal resection of right adrenal disease was performed by retroperitoneal route. During the operation, the tumor was located above the upper pole of the right kidney, and the tumor was enveloped with no adhesion with the inferior vena cava and renal artery and vein, carefully separated, and the tumor was completely removed. The size of the removed tumor specimen was 2.2cm *2cm *1.3cm, the capsule was intact, and the gross view of the tumor specimen was gray-black and soft (see Fig. 2 A). Pathological examination (sees Fig. 3 A-F): showing the right adrenal cortex adenoma cells with abundant cytoplasm and visible lipofuscin granules, maldistribution, small nucleoli were seen in some cells (Figure A); at a low-magnification level, the lesion consists of well circumdemarcously circumscribed nodules with peripheral fibrous capsule (Figure B); A clear demarcation band between normal tissue, The surrounding tissue were composed of normal adrenal cortex (Figure C); tumor cells are composed of tightly packed eosinophilic adrenal cortical cells, Corines are formed between cells (Figure D); The components of adrenal medulla were seen around some tumor cells (Figure E); Fatty metaplasia was seen in the tumor cells (Figure F). Immunohistochemistry (see Fig. 4 A-G): Syn (+), CgA (-), CD56 (+), Ki-67 (3%), CKL (+), α -Inhibin (+), Calretinin (+), NSE (-), S100 (-), EMA (-), CEA (-), SD-HB (+). Pathological diagnosis: Right eosinophilic adrenocortical adenoma. The patient recovered well after surgery with a blood pressure of 132 / 72mmHg and was discharged with cortisol hormone replacement therapy and tapering. At follow-up 1 month later, the patient's blood pressure was 125 / 82 mmHg and blood cortisol returned to normal. Discussion Pigmented adrenocortical adenoma is a rare type of adrenal adenoma. Referring to many cases of [ 1 – 5 ], the incidence probability is not clear, and it is difficult to make a clear diagnosis through patient symptoms, tumor size, imaging examination and laboratory examination, and easy to be confused with other adrenal diseases. Therefore, the diagnosis still depends on postoperative pathological examination and immunohistochemical examination. Currently, the disease can be classified into functional and nonfunctional categories based on the endocrine activity. Functional adenomas can present with Cushing's syndrome [ 6 ], primary hyperaldosteronism, and abnormal adrenal symptoms. At present, the report mainly shows Cushing's syndrome, and the typical symptoms and signs are concentric obesity, hypertension, multiple blood quality, purple lines, full moon face, buffalo back, etc. No functional adenoma, no abnormal clinical manifestations, generally found in physical examination, adrenal space [ 7 ]. According to several cases, pigmented adrenocortical adenoma currently has an unclear onset probability, with low or undetectable serum ACTH levels. Most of the patients are female (71% female, 29% male), and are usually diagnosed 2–3 years after the first onset.[ 8 – 11 ] Adrenal cortical adenoma postoperative specimen section of the vast majority is brown or black, difficult and pigmented adrenocortical adenoma, through the literature reference, easy to confuse the object mainly has three categories: functional pigmented adrenocortical adenoma, no functional pigmented adrenocortical adenoma, the adrenal adenoma disease. Therefore, it can be distinguished by the postoperative pathological summary. In functional pigmented adrenocortical adenomas, it is necessary to differentiate pigmented pheochromocytoma, adrenocortical carcinoma, and melanoma in postoperative pathology [ 12 , 13 ]. The differentiation from chromatic pheochromocytoma depends on immunohistochemistry (neuroendocrine markers synaptophysin, chromatin and neuron-specific enolase) and electron microscopy (neurosecretory granules); studies show that neuroendocrine markers and neurosecretory granules are only present in [ 14 – 17 ] in pheochromocytoma. Identification from adrenocortical carcinoma, where cells with S100 or HMB45 staining were negative for [ 13 ], and immunohistochemistry was also feasible for correct diagnosis. Differating from melanoma, 18 F-FDG was sensitive in melanoma diagnosis, with positive results of 96%, false-negative scans relatively rare (4%), and false-negative results correlated with tumor size [ 18 ]. Early 18 F-FDG examination has a positive significance for the detection and timely diagnosis and treatment of the lesions. In nonfunctional pigmented adrenocortical adenomas, the adenoma volume is small, generally less than 5cm, and the markers S100 and HMB 45 negative [ 13 ], which is diagnosed by microscopy and immunohistochemical examination. In non-adrenal adenoma disease, postoperative pathology will be differentiated from adrenal hematoma, which can be visualized with hemosiderin macrophages, whose histological features are completely different from PAM, and can be diagnosed based on imaging examination and related medical history. In this case, the adrenal gland was occupied by physical examination without any clinical symptoms. The tumor size of CT examination was about 1.8cm×1.4cm, and the enhancement scan showed mild and progressive enhancement. A functional adenoma was not ruled out before surgery. Although the patient preoperative serum adrenocorticotropic hormone, plasma cortisol is normal, but still according to the preoperative preparation of functional adenoma, oral phenol 2 weeks after retroperitoneal laparoscopic right adrenal resection [ 19 ], postoperative macroscopic tumor specimen for gray black soft, pathological, diagnosis of right eosinophilic adrenocortical adenoma, and postoperative cortisol replacement treatment, gradually reduced to avoid the adrenal crisis, the total course of treatment for 4 weeks, after the treatment and review the hormone level according to the corresponding endocrine activity. Conclusion The diagnosis of pigmented adrenocortical adenoma still depends on postoperative pathological examination and immunohistochemical examination. Surgical resection is the main treatment of the disease, mostly benign tumors with good prognosis. Long-term postoperative follow-up should be performed for potentially malignant adrenocortical adenoma. Declarations Author contributions YHZ and WDY wrote the manuscript; WHRand LXM supervise the research project; FRL and YSH revised key content; XLcompiled tables and data; All the authors reviewed the manuscript. Funding This project is supported by the Joint special project of Kunkun-Medical Department of Yunnan Province (approval number :202401AY070001-080); Scientific Research Fund Project of Education Department of Yunnan Province (Approval number :2023Y0648); Project Fund of the Second Affiliated Hospital of Kunming Medical University, Yunnan Province (Approval number :2021yk015); Funded by the 2023 Talent Echelon Cultivation Project of the Second Affiliated Hospital of Kunming Medical University (RCTDHB-202305) Conflict of Interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Ethics statement Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article. References Hou Xiaoyan, Huang Suiqiao. A case report of atypical pigmented adrenocortical adenoma [J]. Lingnan Modern Clinical Surgery,2012,12(01):73-74. Le Keping, Gu Yining, Liu Chunlin et al. A case report of functional pigmented adrenocortical adenoma complicated with hemorrhagic shock [J]. Journal of Modern Urogenital Oncology,2010,2(02):116. Wang Liang, Zhao Jun, Nie Xiu et al. Functional pigmented cortical adenoma of adrenal gland: a case report and literature review [J]. Journal of Clinical Urology,2005(12):750-751. ZhA Lianglun, Zhao Weipeng, Huang Shitong. Pigmented functional adrenocortical adenoma: a case report [J]. Journal of Shanghai Medical University,1987(02):106-163. Zou Wanzhong, Li Jingxian. Chromic adenoma of adrenal cortex: A case report [J]. 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PMID: 30259502; PMCID: PMC6347113. Liu X, Zhang S, Guo Y, Gang X, Wang G. Treatment of Primary Pigmented Nodular Adrenocortical Disease. Horm Metab Res. 2022 Nov;54(11):721-730. doi: 10.1055/a-1948-6990. Epub 2022 Sep 21. PMID: 36130700; PMCID: PMC9649297. Xing H, Ahn J, Kim L, P'ng CH. Primary pigmented nodular adrenocortical disease. Pathology. 2024 Feb;56(1):131-133. doi: 10.1016/j.pathol.2023.06.007. Epub 2023 Aug 21. PMID: 37679255. Xu B, Hong Y, Jin M, Li M, Wang C, Wang X. Primary adrenal malignant melanoma: A case report and review of literature. Medicine (Baltimore). 2017 Dec;96(51):e8956. doi: 10.1097/MD.0000000000008956. PMID: 29390427; PMCID: PMC5758129. Visser JW, Boeijinga KD, Meer CV. A functioning black adenoma of the adrenal cortex: a clinico-pathological entity. J Clin Pathol. 1974 Dec;27(12):955-9. doi: 10.1136/jcp.27.12.955. PMID: 4452744; PMCID: PMC475562. Amérigo J, Roig J, Pulido F, Belda R, Vázquez-Ramírez FJ, González-Cámpora R. Primary malignant melanoma of the adrenal gland. Surgery. 2000 Jan;127(1):107-11. doi: 10.1067/msy.2000.100467. PMID: 10660767. Zalatnai A, Szende B, Tóth M, Rácz K. Primary malignant melanoma of adrenal gland in a 41-yr-old woman. Endocr Pathol. 2003 Spring;14(1):101-5. doi: 10.1385/ep:14:1:101. PMID: 12746568. Granero LE, Al-Lawati T, Bobin JY. Primary melanoma of the adrenal gland, a continuous dilemma: report of a case. Surg Today. 2004;34(6):554-6. doi: 10.1007/s00595-004-2740-6. PMID: 15170557. Bastide C, Arroua F, Carcenac A, Anfossi E, Ragni E, Rossi D. Primary malignant melanoma of the adrenal gland. Int J Urol. 2006 May;13(5):608-10. doi: 10.1111/j.1442-2042.2006.01365.x. PMID: 16771734. Holder WD Jr, White RL Jr, Zuger JH, Easton EJ Jr, Greene FL. Effectiveness of positron emission tomography for the detection of melanoma metastases. Ann Surg. 1998 May;227(5):764-9; discussion 769-71. doi: 10.1097/00000658-199805000-00017. PMID: 9605668; PMCID: PMC1191363. Zografos GN, Pappa T, Avlonitis S, Markou A, Chrysikos DT, Kaltsas G, Aggeli C, Piaditis G. Primary pigmented nodular adrenocortical disease presenting with a unilateral adrenocortical nodule treated with bilateral laparoscopic adrenalectomy: a case report. J Med Case Rep. 2010 Jul 29;4:230. doi: 10.1186/1752-1947-4-230. PMID: 20670433; PMCID: PMC2923167. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editor assigned by journal 15 Apr, 2024 Submission checks completed at journal 15 Apr, 2024 First submitted to journal 14 Apr, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4265988","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":291435362,"identity":"10764dae-e01c-4ea7-a168-56df2661d36d","order_by":0,"name":"hongzhi ye","email":"","orcid":"","institution":"the Second Affiliated Hospital of Kunming Medical University","correspondingAuthor":false,"prefix":"","firstName":"hongzhi","middleName":"","lastName":"ye","suffix":""},{"id":291435363,"identity":"69069591-2b65-47dd-a8cc-997970d80c67","order_by":1,"name":"Run-lin Feng","email":"","orcid":"","institution":"the Second Affiliated Hospital of Kunming Medical University","correspondingAuthor":false,"prefix":"","firstName":"Run-lin","middleName":"","lastName":"Feng","suffix":""},{"id":291435364,"identity":"ea79ab2c-63d9-4360-8d1c-40faac8af699","order_by":2,"name":"Dai-yan Wen","email":"","orcid":"","institution":"the Second Affiliated Hospital of Kunming Medical University","correspondingAuthor":false,"prefix":"","firstName":"Dai-yan","middleName":"","lastName":"Wen","suffix":""},{"id":291435365,"identity":"23ab478b-896a-445e-ae8a-5ab6fb8e330e","order_by":3,"name":"Hai-rong Wei","email":"","orcid":"","institution":"the Second Affiliated Hospital of Kunming Medical University","correspondingAuthor":false,"prefix":"","firstName":"Hai-rong","middleName":"","lastName":"Wei","suffix":""},{"id":291435366,"identity":"9f0e5e60-3b3c-43cf-b557-c8981f7fe553","order_by":4,"name":"Xiang-meng Li","email":"","orcid":"","institution":"the Second Affiliated Hospital of Kunming Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiang-meng","middleName":"","lastName":"Li","suffix":""},{"id":291435367,"identity":"1f7d92e8-3e2b-4a6c-99bc-ccb9a9a332c5","order_by":5,"name":"Liang Xi","email":"","orcid":"","institution":"the Second Affiliated Hospital of Kunming Medical University","correspondingAuthor":false,"prefix":"","firstName":"Liang","middleName":"","lastName":"Xi","suffix":""},{"id":291435368,"identity":"2b159651-653d-4ebd-b5bc-ee7ae70f0a40","order_by":6,"name":"Shun-hui Yuan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8ElEQVRIiWNgGAWjYFACHoaDHyps5PjZ2w8+ADIY2IjQwnhY4kyasWTPmWTDGWfSiNLCfIC37XDihhsJZtJABmENBufPHjgAssXgRkKa5Iwz5+35pJsfMPyo2IZby428hAMFQL9Innl42OJDxe3ENpljBow9Z27j0cJjALaF73hC4s0ZZ24nsEkkGDAztuHRcv6MAdgvDQcSDIB+OWfPJpH+Ab+WAzkQLRNOJBgBtRxgbJPIwW+L5I0cA+RATk4Eaik4iM8vfOfPGH9Eiko7e/kZ6Rsf/KjArUXhADZRrIIwIN+AT3YUjIJRMApGAQgAAGHraFNGRbltAAAAAElFTkSuQmCC","orcid":"","institution":"the Second Affiliated Hospital of Kunming Medical University","correspondingAuthor":true,"prefix":"","firstName":"Shun-hui","middleName":"","lastName":"Yuan","suffix":""}],"badges":[],"createdAt":"2024-04-14 18:14:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4265988/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4265988/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":55249535,"identity":"a6b170bf-ae90-41ac-adca-9e79583cd148","added_by":"auto","created_at":"2024-04-24 17:29:33","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":54225,"visible":true,"origin":"","legend":"\u003cp\u003eenhanced CT: circular occupancy in the right adrenal gland\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4265988/v1/e98e8e033ee1cd3541dafeca.png"},{"id":55249531,"identity":"6e524a42-7512-4cd5-8c2f-c940db5c4e9b","added_by":"auto","created_at":"2024-04-24 17:29:32","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":454244,"visible":true,"origin":"","legend":"\u003cp\u003eB: The postoperative specimen is gray-black and soft\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4265988/v1/7b6624da2f462354cfbff430.png"},{"id":55249533,"identity":"ce3ef3bf-ce0f-4f99-aec4-6095936a56d2","added_by":"auto","created_at":"2024-04-24 17:29:32","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":799168,"visible":true,"origin":"","legend":"\u003cp\u003eA-F: (A) adenoma cells are rich in cytoplasm and lipofuscin particles, with small nucleoli in some cells; (B) lesions composed of well-defined circumscribed peripheral fibrous capsule nodules (H \u0026amp; E low times); (C) obvious demarcation zone between normal tissue; (D) tumor cells composed of closely packed eosinophilic adrenal cortical cells with cable arrangement between the cells; (E) adrenal medullary components visible around some of the tumor cells; (F) fatty metaplasia in tumor cells.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4265988/v1/b27d4224ce82c2d9dcdf3b05.png"},{"id":55249534,"identity":"e98c5c64-f126-4b1d-a07c-dc1889465a62","added_by":"auto","created_at":"2024-04-24 17:29:32","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":963030,"visible":true,"origin":"","legend":"\u003cp\u003eA-G: Immunohistochemical staining was positive for CD56 (a), CKL (c), Calretinin (d), α -Inhibin (e), and Syn (g).\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-4265988/v1/e5f5394233cbcc5f213be2b2.png"},{"id":55250859,"identity":"f9da4417-985a-4ff5-a814-fc9fe3e0f648","added_by":"auto","created_at":"2024-04-24 17:37:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2231647,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4265988/v1/b6a9c4f9-6fa3-4c90-9e4f-b436788cc176.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Pigmented adrenocortical adenoma: a case report","fulltext":[{"header":"Case presentation","content":"\u003cp\u003eThe patient was a 55-year-old female, who was admitted to the urology ward of our hospital on April 6,2021 due to physical examination. The patient had no symptoms of headache, palpitations, sweating, blurred vision and vertigo. Physical examination: mild tenderness in the right renal area, blood pressure: 138 / 91mmHg, laboratory examination: angiotensin 226.71pg/ml, and the rest was normal (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Imaging examination: renal artery CT spiral plain scan\u0026thinsp;+\u0026thinsp;enhancement\u0026thinsp;+\u0026thinsp;X-ray computerized layer imaging: the right adrenal gland saw circular space, clear boundary, equal density, size about 1.8cm*1.4cm, sees Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA, enhanced scan showed mild progressive enhancement. The left adrenal gland had normal morphology, size, uniform density, no nodules or masses, and uniform enhancement after enhancement. ct in both renal arteries showed no significant abnormalities. B ultrasound suggests: in the right adrenal area, the boundary is still clear, and the size is about 2.0cm *1.6cm. Preliminary diagnosis is: the right adrenal gland occupancy, more consideration of adenoma.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRenin\u0026thinsp;+\u0026thinsp;angiotensin (Vertical position)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eabbreviation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eproject name\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ebear fruit\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eunit\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ereference ranges\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAngiotensin measurement (lying position)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e226.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003epg/ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25\u0026ndash;129\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRenin (lying position)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003epg/ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAldosterone assay(clinostatism)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003epg/ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u0026ndash;160\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ealdosterone /Renin (lying)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAngiotensin Measurement (Standing Position)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e207.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003epg/ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e49\u0026ndash;252\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRenin (standing position)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003epg/ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u0026ndash;38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAldosterone assay(erect position)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e106.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003epg/ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40\u0026ndash;310\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ealdosterone /Renin (standing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCircadian rhythm determination of plasma cortisol ACTH\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eabbreviation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eproject name\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ebear fruit\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eunit\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ereference ranges\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACTH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSerum corticotropin measurement: (8:00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003epg/ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.2\u0026ndash;63.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACTH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSerum adrenocorticotropic hormone measurement: (16:00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003epg/ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACTH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSerum adrenocorticotropic hormone measurement: (24:00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003epg/ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePlasma cortisol measurement (8:00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eug/dl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.62\u0026ndash;24.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePlasma cortisol measurement (8:00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eug/dl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.9\u0026ndash;17.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePlasma cortisol measurement (8:00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eug/dl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Treatment and pathological findings","content":"\u003cp\u003eTreatment: α -blocker was treated for 2 weeks before surgery, 1500ml intravenous drip crystals and colloidal fluid were given 3 days before surgery, and laparoscopic retroperitoneal resection of right adrenal disease was performed by retroperitoneal route. During the operation, the tumor was located above the upper pole of the right kidney, and the tumor was enveloped with no adhesion with the inferior vena cava and renal artery and vein, carefully separated, and the tumor was completely removed. The size of the removed tumor specimen was 2.2cm *2cm *1.3cm, the capsule was intact, and the gross view of the tumor specimen was gray-black and soft (see Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA). Pathological examination (sees Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA-F): showing the right adrenal cortex adenoma cells with abundant cytoplasm and visible lipofuscin granules, maldistribution, small nucleoli were seen in some cells (Figure A); at a low-magnification level, the lesion consists of well circumdemarcously circumscribed nodules with peripheral fibrous capsule (Figure B); A clear demarcation band between normal tissue, The surrounding tissue were composed of normal adrenal cortex (Figure C); tumor cells are composed of tightly packed eosinophilic adrenal cortical cells, Corines are formed between cells (Figure D); The components of adrenal medulla were seen around some tumor cells (Figure E); Fatty metaplasia was seen in the tumor cells (Figure F). Immunohistochemistry (see Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eA-G): Syn (+), CgA (-), CD56 (+), Ki-67 (3%), CKL (+), α -Inhibin (+), Calretinin (+), NSE (-), S100 (-), EMA (-), CEA (-), SD-HB (+). Pathological diagnosis: Right eosinophilic adrenocortical adenoma. The patient recovered well after surgery with a blood pressure of 132 / 72mmHg and was discharged with cortisol hormone replacement therapy and tapering. At follow-up 1 month later, the patient's blood pressure was 125 / 82 mmHg and blood cortisol returned to normal.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePigmented adrenocortical adenoma is a rare type of adrenal adenoma. Referring to many cases of [\u003cspan additionalcitationids=\"CR2 CR3 CR4\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], the incidence probability is not clear, and it is difficult to make a clear diagnosis through patient symptoms, tumor size, imaging examination and laboratory examination, and easy to be confused with other adrenal diseases. Therefore, the diagnosis still depends on postoperative pathological examination and immunohistochemical examination. Currently, the disease can be classified into functional and nonfunctional categories based on the endocrine activity. Functional adenomas can present with Cushing's syndrome [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], primary hyperaldosteronism, and abnormal adrenal symptoms. At present, the report mainly shows Cushing's syndrome, and the typical symptoms and signs are concentric obesity, hypertension, multiple blood quality, purple lines, full moon face, buffalo back, etc. No functional adenoma, no abnormal clinical manifestations, generally found in physical examination, adrenal space [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. According to several cases, pigmented adrenocortical adenoma currently has an unclear onset probability, with low or undetectable serum ACTH levels. Most of the patients are female (71% female, 29% male), and are usually diagnosed 2\u0026ndash;3 years after the first onset.[\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAdrenal cortical adenoma postoperative specimen section of the vast majority is brown or black, difficult and pigmented adrenocortical adenoma, through the literature reference, easy to confuse the object mainly has three categories: functional pigmented adrenocortical adenoma, no functional pigmented adrenocortical adenoma, the adrenal adenoma disease. Therefore, it can be distinguished by the postoperative pathological summary. In functional pigmented adrenocortical adenomas, it is necessary to differentiate pigmented pheochromocytoma, adrenocortical carcinoma, and melanoma in postoperative pathology [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The differentiation from chromatic pheochromocytoma depends on immunohistochemistry (neuroendocrine markers synaptophysin, chromatin and neuron-specific enolase) and electron microscopy (neurosecretory granules); studies show that neuroendocrine markers and neurosecretory granules are only present in [\u003cspan additionalcitationids=\"CR15 CR16\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] in pheochromocytoma. Identification from adrenocortical carcinoma, where cells with S100 or HMB45 staining were negative for [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], and immunohistochemistry was also feasible for correct diagnosis. Differating from melanoma, 18 F-FDG was sensitive in melanoma diagnosis, with positive results of 96%, false-negative scans relatively rare (4%), and false-negative results correlated with tumor size [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Early 18 F-FDG examination has a positive significance for the detection and timely diagnosis and treatment of the lesions. In nonfunctional pigmented adrenocortical adenomas, the adenoma volume is small, generally less than 5cm, and the markers S100 and HMB 45 negative [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], which is diagnosed by microscopy and immunohistochemical examination. In non-adrenal adenoma disease, postoperative pathology will be differentiated from adrenal hematoma, which can be visualized with hemosiderin macrophages, whose histological features are completely different from PAM, and can be diagnosed based on imaging examination and related medical history. In this case, the adrenal gland was occupied by physical examination without any clinical symptoms. The tumor size of CT examination was about 1.8cm\u0026times;1.4cm, and the enhancement scan showed mild and progressive enhancement. A functional adenoma was not ruled out before surgery. Although the patient preoperative serum adrenocorticotropic hormone, plasma cortisol is normal, but still according to the preoperative preparation of functional adenoma, oral phenol 2 weeks after retroperitoneal laparoscopic right adrenal resection [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], postoperative macroscopic tumor specimen for gray black soft, pathological, diagnosis of right eosinophilic adrenocortical adenoma, and postoperative cortisol replacement treatment, gradually reduced to avoid the adrenal crisis, the total course of treatment for 4 weeks, after the treatment and review the hormone level according to the corresponding endocrine activity.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe diagnosis of pigmented adrenocortical adenoma still depends on postoperative pathological examination and immunohistochemical examination. Surgical resection is the main treatment of the disease, mostly benign tumors with good prognosis. Long-term postoperative follow-up should be performed for potentially malignant adrenocortical adenoma.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYHZ and WDY wrote the manuscript; WHRand LXM supervise the research project; FRL and YSH revised key content; XLcompiled tables and data; All the authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis project is supported by the Joint special project of Kunkun-Medical Department of Yunnan Province (approval number :202401AY070001-080); Scientific Research Fund Project of Education Department of Yunnan Province (Approval number :2023Y0648); Project Fund of the Second Affiliated Hospital of Kunming Medical University, Yunnan Province (Approval number :2021yk015); Funded by the 2023 Talent Echelon Cultivation Project of the Second Affiliated Hospital of Kunming Medical University (RCTDHB-202305)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHou Xiaoyan, Huang Suiqiao. A case report of atypical pigmented adrenocortical adenoma [J]. Lingnan Modern Clinical Surgery,2012,12(01):73-74.\u003c/li\u003e\n\u003cli\u003eLe Keping, Gu Yining, Liu Chunlin et al. A case report of functional pigmented adrenocortical adenoma complicated with hemorrhagic shock [J]. Journal of Modern Urogenital Oncology,2010,2(02):116.\u003c/li\u003e\n\u003cli\u003eWang Liang, Zhao Jun, Nie Xiu et al. Functional pigmented cortical adenoma of adrenal gland: a case report and literature review [J]. Journal of Clinical Urology,2005(12):750-751.\u003c/li\u003e\n\u003cli\u003eZhA Lianglun, Zhao Weipeng, Huang Shitong. Pigmented functional adrenocortical adenoma: a case report [J]. Journal of Shanghai Medical University,1987(02):106-163.\u003c/li\u003e\n\u003cli\u003eZou Wanzhong, Li Jingxian. Chromic adenoma of adrenal cortex: A case report [J]. Journal of Beijing Medical College,1982(03):305-306+327.\u003c/li\u003e\n\u003cli\u003eGuo Xudong, Wang Hanbo, Ren Xiangbin, et al. 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Int J Urol. 2006 May;13(5):608-10. doi: 10.1111/j.1442-2042.2006.01365.x. PMID: 16771734.\u003c/li\u003e\n\u003cli\u003eHolder WD Jr, White RL Jr, Zuger JH, Easton EJ Jr, Greene FL. Effectiveness of positron emission tomography for the detection of melanoma metastases. Ann Surg. 1998 May;227(5):764-9; discussion 769-71. doi: 10.1097/00000658-199805000-00017. PMID: 9605668; PMCID: PMC1191363.\u003c/li\u003e\n\u003cli\u003eZografos GN, Pappa T, Avlonitis S, Markou A, Chrysikos DT, Kaltsas G, Aggeli C, Piaditis G. Primary pigmented nodular adrenocortical disease presenting with a unilateral adrenocortical nodule treated with bilateral laparoscopic adrenalectomy: a case report. J Med Case Rep. 2010 Jul 29;4:230. doi: 10.1186/1752-1947-4-230. PMID: 20670433; PMCID: PMC2923167.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"adrenal tumor, pathological diagnosis, immunohistochemistry","lastPublishedDoi":"10.21203/rs.3.rs-4265988/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4265988/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePigmentary adrenal cortical adenoma is a special type of adrenal adenoma. The adenoma cells contain a large amount of lipofuscin or neuromelanin, which is brown-black in visual appearance. According to the reports of many cases, the incidence probability is not clear at present. Therefore, it is a topic worth exploring in terms of preferred treatment, pathological diagnosis and differentiation from other types of adrenal adenomas. Here we report a case of a nonfunctional pigmentary adrenocortical adenoma with a specific pathological pattern, the diagnosis of which depends on postoperative pathological examination and immunohistochemical examination. Surgical resection is the main treatment for this disease, most of the benign tumors have a good prognosis, and long-term postoperative follow-up should be carried out for potential malignant adrenal cortical adenomas.\u003c/p\u003e","manuscriptTitle":"Pigmented adrenocortical adenoma: a case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-24 17:29:26","doi":"10.21203/rs.3.rs-4265988/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorAssigned","content":"","date":"2024-04-15T14:02:01+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-04-15T14:02:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Urology","date":"2024-04-14T18:00:02+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"132fe331-f7d1-4950-8432-d4924c198b5c","owner":[],"postedDate":"April 24th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-04-24T17:29:26+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-24 17:29:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4265988","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4265988","identity":"rs-4265988","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}