Heart failure in a 10-year-old girl: incidental discovery of adrenal adenoma by cardiac MRI—case report

Functional adrenal adenoma is uncommon in children, and cardiovascular complications, such as dilated cardiomyopathy and heart failure (HF), are rare as initial manifestations.

Here, we report a 10-year-old girl presenting with acute HF, mild troponin rise and severe left ventricular dysfunction in echocardiography. The Cardiac magnetic resonance imaging (CMR) demonstrated dilated cardiomyopathy, with a left ventricular ejection fraction (LVEF) of 17% with concentric left ventricular hypertrophy and a focal myocardial infarction. Extracardiac findings in CMR showed an incidental 3-cm right adrenal mass, and subsequent dedicated MRI with adrenal protocol showed features of a benign adenoma. Laboratory findings showed mixed Cushing's and hyperaldosteronism suggestive of a functional adrenal adenoma. The radical right adrenalectomy was performed, and pathology confirmed the diagnosis.

In the 1-year follow-up echocardiography, the LVEF was back to normal (55%), highlighting the reversible nature of cardiomyopathy in this condition.