Endocrine Abstracts

Introduction: Adrenal glands are common sites for secondary lesions derived from malignant tumours (lymphoma, melanoma, renal, breast, colon, and bronchopulmonary cancer). Patients with adrenal secondary lesions are typically asymptomatic but 1% may present with adrenal insufficiency as a first manifestation. We report the cases of two males with lung adenocarcinoma, first presented with acute adrenal insufficiency.

Cases presentation: Case 1: LC, 65 years old, was hospitalised for acute asthenia, anorexia, severe digestive disorder, weight loss, and hypotension, associated with hypokalaemia. Adrenal insufficiency was confirmed by increased ACTH (344 pg/ml) and low-normal cortisol (6.38 μg/dl). Steroid substitution was started with amelioration of the general status. Abdominal imagery (ultrasonography and CT) revealed enlarged adrenals and a probable secondary hepatic lesion. Liver biopsy suggested a pulmonary adenocarcinoma metastasis, for which chemotherapy was started, with favorable evolution.

Case 2: BV, 57 years old, heavy smoker and drinker, decompensated, after an intervention for Dupuytren retraction, with a primary adrenal insufficiency confirmed by the biological data. Steroid substitution was started with a good initial evolution but after 3 months he stopped the treatment and was hospitalized with adrenal crisis (cortisol <1 μg/dl). Intensive treatment was efficient but the persistence of anorexia, asthenia, and inflammatory syndrome suggested a severe underlying cause. Pulmonary radiography showed a right apical lung nodule confirmed by thoraco-abdominal CT, which also revealed bilateral adrenal invasion. Pulmonary biopsy confirmed poorly differentiated adenocarcinoma and chemotherapy schema was proposed.

Conclusions: The frequency of adrenal metastasis of primary lung cancer increases with disease progression, from 10 to 40%. However, clinical manifestations of adrenal insufficiency are significantly less frequent, probably because a destruction of more than 90% of adrenal cortex is needed for clinical symptoms. Adrenal crisis was, in our two cases, the first symptom of advanced pulmonary cancer, leading to its diagnostic and therapeutic solutions.