DOI: https://doi.org/10.36347/sjmcr.2026.v14i03.038

Pages: 478-480

Adrenal incidentalomas are adrenal masses discovered incidentally during imaging performed for reasons unrelated to adrenal disease. While most incidentalomas are benign and non-functioning adenomas, cystic adrenal lesions are rare, accounting for less than 1% of all adrenal tumors. Bilateral presentation is exceptional, and giant forms are even more uncommon, posing diagnostic and therapeutic challenges. We report the case of a 19-year-old woman with no significant medical history who presented with progressive asthenia. Imaging revealed bilateral cystic adrenal masses, including a giant left-sided lesion measuring 14 cm in its largest axis. Comprehensive hormonal evaluation was normal, excluding a functional adrenal tumor. Hydatid serology was negative. Given the size of the left-sided lesion and the potential risk of complications, surgical management with cyst aspiration was performed. Histopathological examination confirmed a benign adrenal pseudocyst without cellular atypia or malignancy. The smaller, asymptomatic right-sided cysts were managed conservatively with regular clinical, biological, and radiological follow-up. This case highlights the rarity of bilateral giant cystic adrenal incidentalomas and emphasizes the importance of systematic hormonal assessment, careful radiological evaluation, and individualized management to balance the risks of complications and adrenal insufficiency.