Endocrine Abstracts

The adrenal glands are common metastatic sites of lung and other cancers. Secondary adrenal hemorrhage due to these metastases is extremely rare and to our knowledge, only 3 cases have been described in literature. We present a patient who developed hypoadrenalism due to bilateral adrenal hemorrhage secondary to adrenal metastases from lung carcinoma. A 66 year old man with a 3 year history of non-small cell lung cancer previously treated with neo-adjuvant chemo-radiotherapy presented with bilateral loin pain and lethargy. A PET-Computed Tomography scan (CT) revealed enlarged adrenals with haemorrhage. A short synacthen test showed inadequate cortisol response to synthetic ACTH. (Baseline cortisol 190 mmol/l, peak 241 mmol/l). The patient was commenced on oral steroid replacement (Hydrocortisone 10 mg at 8 am, 5 mg at 12noon, 5 mg at 6 pm). There was no clinical evidence of mineralocorticoid deficiency. Serial adrenal imaging showed gradual resolution of hemorrhage with residual necrosis. Adrenal hemorrhage is a rare condition with a variable presentation that may lead to acute adrenal crisis, shock, and death unless recognised and treated promptly. Its pathologic characteristics include bilateral gland involvement with extensive necrosis of all 3 cortical layers and of medullary adrenal cells. The short synacthen stimulation test confirms the diagnosis of adrenal insufficiency. CT of the adrenals is the study of choice for demonstrating adrenal hemorrhage in the acute setting. Out-patient follow up is recommended to monitor adequate and exclude adverse effects of glucocorticoid replacement therapy. Follow-up evaluation with the short synacthen stimulation test is used to assess recovery of adrenal function.

Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.