Endocrine Abstracts

JOINT3478

Clinical case: A 67 years old male patient with a history of right upper lobe lung adenocarcinoma (LUAD) with pleural invasion, treated with surgery, chemo- and radiotherapy, presented a small left adrenal mass documented since the initial LUAD diagnosis. The lesion never posed any interest for three years as it never caused adrenal dysfunction, it was stable in size (14 mm) and it never proved any metabolic activity on two earlier 18F-FDG PET/CT scans. In the fourth year since the LUAD diagnosis, a routine thorax-to-pelvis PET/CT revealed a single metabolically active lesion which was the already documented adrenal mass (SUVmax: 4.19), previously deemed benign, prompting the patient’s referral our clinic. No endocrinological evaluation had been performed since the diagnosis. The patient lacked clinical signs of adrenal dysfunction and had normal adrenal hormone levels. Given the left nodule’s history and the patient’s refusal of surgery, a short-term ‘watchful waiting’ approach was decided. Three months after the initial presentation, a CT scan showed significant growth of the previously known left nodule (24×21×14 mm vs 14 mm), a new left adrenal mass of 14×9×15 mm and a new right adrenal mass of 16×11×16 mm. An additional head-to-pelvis PET/CT showed intense activity confined only to the left (SUVmax: 10.31 vs 4.19, respectively SUVmax: 4.88) and right (SUVmax: 5.33) adrenals. As metastatic LUAD was suspected due to the rapid changes in an incredibly short period, the therapeutic decision was bilateral adrenalectomy. Due to the patient’s reluctance to the recommended treatment, only a left adrenalectomy was performed. The histopathological and immunohistochemical analysis confirmed LUAD histogenesis, with positive expression of TTIF-1 and Napsin A. Three months post-operation, an MRI revealed an increase in the size of the right adrenal nodule (23×24 mm). As the patient refused additional surgery, stereotactic radiotherapy was performed on the remaining lesion following a radiotherapy consultation, resulting in partial adrenal insufficiency. The adrenal glands are a common site for metastasis in patients with lung cancer. There is controversy regarding the route by which the cancerous cells of the primary disease reach the adrenal gland. Unilateral adrenal metastases are deemed rare and when they do occur, the ipsilateral adrenal is typically affected first. In this case, despite the initially stable solitary lesion limited only to the left contralateral adrenal, alongside the LUAD, we would have advocated for active surveillance since the exact nature and potential progression of the adrenal mass remains uncertain.