Endocrine Abstracts

Background: Ectopic Cushing’s syndrome is a paraneoplastic syndrome characterised by adrenocorticotropic hormone (ACTH) secretion from malignant cells. This can in turn result in overstimulation of the adrenal cortex and adrenal cortical hyperplasia. Resulting hypercortisolism can lead to a host of complications for the patient, including hypertension and hypokalaemia. The aim of this cadaver report is to discuss an unusual case of metastatic lung cancer, presenting with bilateral adrenal hyperplasia and two abdominal aortic aneurysms (AAA). Reports containing documented evidence of bilateral adrenal hyperplasia in the context of paraneoplastic syndromes are rare and serve as the motivation behind this report.

Case presentation: An 84-year-old white, male cadaver was dissected. Sectioning of the right lung revealed a pale-yellow mass measuring 10.0 × 7.4 × 7.0 cm. An irregularly defined, necrotic, ulcerated lesion measuring 5.5 × 4.5 × 3.3 cm was present on the lateral surface of the left shoulder and was assumed to be consistent with a history of metastatic lung carcinoma. Upon abdominal dissection, large adrenal glands were noted bilaterally. Given the finding of what macroscopically appeared to be an infiltrative tumour, along with what would be consistent with metastatic tumour to the skin, a conclusion of bilateral adrenal hyperplasia was considered with the right and left adrenal glands measuring 10.0 × 6.5 × 4.5 cm and 7.3 × 4.7 × 3.5 cm, respectively. There were also two AAAs, measuring 6.0 cm and 11.0 cm at their respective widest transverse diameters.

Conclusion: We propose that bilateral adrenal hyperplasia occurred secondary to lung cancer-related paraneoplastic Cushing syndrome. Resulting hypercortisolism may have propagated the growth of the abdominal aortic aneurysms.