Adrenal metastasis is common (35%) among the patients with lung cancer, while less than 3% of the patients develop bilateral adrenal metastasis. Adrenal metastases are generally small and clinically asymptomatic. Adrenal insufficiency is rare despite the presence of adrenal metastasis. Lam et al. reported this ratio as 0.7%. We aimed to present a case with lung cancer and bilateral adrenal metastasis who developed adrenal insufficiency.
A 63-year old male patient was presented with cough. Chest X-ray revealed a mass lesion in the upper zone of left lung. PET/CT examination was performed and demonstrated increased FDG uptake in upper lobe mass lesion of left lung, mediastinal lymph nodes, bilateral surrenal glands (9 mm at the right and 5.5×2 cm at the left),liver and bones. Following bronchoscopy, the patient was diagnosed with non-small cell lung cancer. Pathologic examination of surrenal biopsy material revealed surrenal metastasis. The patient had no signs of adrenal insufficiency and electrolyte imbalance at the time of diagnosis. He was scheduled for cisplatin+gemcitabine chemotherapy. Although lung and adrenal gland lesions were stable within 6 months after treatment, the patient developed hypoglycemia, hypovolemia, hyponatremia and hyperkalemia. Laboratory examination revelaed ACTH:1250 pg/ml (normal: 046), and cortisol 4.43 μg/dl (n:529). The patient was given prednisolone and fludrocortisone treatment with the diagnosis of adrenal insufficiency. Symptoms of the patient were subsided after treatment. Post-treatment laboratory examination revealed Na:138 mEq/l (normal:135145), K: 4 mEq/L/normal:3.55.5) and ACTH:37 pg/ml.
It should be considered that patients with lung cancer and adrenal metastasis may later develop adrenal insufficiency despite the absence of adrenal insufficiency at the time of diagnosis. Although fatigue, nausea, hypotension and hyponatremia may also be seen in the patients with cancer, these may also be the signs of adrenal insufficiency.
20 - 23 May 2017
European Society of Endocrinology