Endocrine Abstracts

Introduction: Adrenal lesions occur in more than 10% of the general population. Most are benign, but 2.5% are metastatic disease to the adrenal from tumors such melanoma, renal, breast, colon and lung carcinoma. Adrenal metastatic disease is usually asymptomatic and diagnosed in the extension study or the primary tumor. However it is unusual as a presentation of an endocrine tumor or like the first manifestation of metastatic disease.

We present two patients with adrenal macrolesions like the first manifestation of metastatic disease of non endocrine tumors.

Case study n 1: A 63 year old male with a history of hypertension well controlled and occasional smoker presents with sudden pain in right iliac fosse after physical exertion. Abdominal CT evidence a right adrenal mass (9×11 cm) and two left adrenal nodules (2 and 1.5 cm) reason why he is admitted to our service. Besides the chest radiography and chest CT revealed a nodule of 2 cm in right upper lobe lung.

Urinary catecholamines were slightly elevated and right adrenalectomy was performed with the suspicion of a macropheochromocytoma. The pathological study was consistent with metastatic lung adenocarcinoma. Extension study shown left adrenal and mesentery metastases, and chemotherapy was started.

Case study n 2: A 83 year old male was diagnosed with ampullary due to repeated episodes of cholangitis. Abdominal MRI showed adrenal masses of 4 and 5.7 cm. Six months after the diagnosis he was admitted to hospital due to acute adrenal insufficiency (Addison disease caused by neoplastic adrenal infiltration). Adrenal replacement therapy has clearly improved his quality of life but not his survival.

Conclusions: – The adrenal macrolesions in patients without known malignancy should be considered as metastases because of the rarity of endocrine tumors in this location.

– The metastatic adrenal involvement in patients with disseminated neoplasms may produce hypoadrenalism that must be treated in order to improve the quality of life of patients.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.