Adrenal Insufficiency Secondary to Metastatic Lung Cancer
Autoimmunity and infectious diseases are the main causes of primary adrenal failure worldwide. All the other causes are extremely rare. Among them, adrenal glands metastization is reported in about 3% of oncologic and non-oncologic patients’ autopsies. Breast and lung cancers are the most common primary tumors. Adrenal failure is identified in only 1% of these adrenal lesions.
A 68-year-old Caucasian male, previously diagnosed of pulmonary emphysema, under no daily medication, was admitted in an Emergency room because of diarrhea, vomits, dizziness and three lipothymia episodes for four weeks. Prostration, adynamia and loss of 8 kg during the previous six months were also reported. Analytic evaluation suggested the diagnosis of primary adrenal failure, which tetracosactide test confirmed. Cervicoabdominopervic computerized tomography (CTAP-CT) identified hypodense lesions in both adrenals, 2 x 2 cm in the left gland and 2 x 1 cm in the right one, of 6 and 11 Hounsfield units, respectively. Interferon gamma release assay excluded tuberculosis. Left adrenal was biopsied under echographic control and identified a lesion suggestive of lung adenocarcinoma metastasis. Positron emission tomography (PET) scan hyperfixated a subpleural speculated right lung lesion not identified in the CT. The patient is being treated with cisplatin and docetaxel, with size reduction of both primary and metastatic lesions. Hydrocortisone 20 mg per day and fludrocortisone 0.1 mg per day were prescribed as hormonal replacement.
Adrenal failure was the first manifestation of lung malignancy. Adrenal metastases were identified prior to lung cancer, what is reported in about 6% of the adrenal metastatic lesions. CT scan did not identify the lung tumour. Furthermore tomodensitometric characteristics were not suspicious. Adrenal biopsy was essential to establish the diagnosis. PET-FDG scan was crucial to the identification of the lung carcinoma.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The authors, when submitting this paper for publication, transfer to “Revista Portuguesa de Endocrinologia, Diabetes e Metabolismo” the rights and copyrights of the article.