Adrenal Metastases from Thyroid Cancers: Three Personal Cases and Literature Review

Abstract

Introduction : Adrenal glands are not a common site for thyroid cancer (TC) metastases. Our aim was to report three adrenal masses, which are likely to be metastases from aggressive thyroid cancers. Case Reports: Case1 : a woman aged 57 harboring an anaplastic TC staged T4b, N1b, M0, consulted for severe fatigue. Clinical examination noted skin hyper pigmentation and a large thyroid mass. Hormonal assessment showed adrenal insufficiency, thyroglobulin =1.4ng/ml. Radiological exploration demonstrated diffuse metastases with two large adrenal tumors (AT) which did not fix radioiodine. According to the context AT were likely to be metastases. She died one month later. Case 2 : a woman aged 56 was referred for oncocytic papillary TC with pulmonary and bone metastases. Thyroglobulin was 450ng/ml. Total body scan showed diffuse metastases with adrenal localizations. Those did not fix radioiodine. Adrenals’ fine nodule aspiration confirmed the thyroid origin. One year later, she is still alive, but with a profound degradation of her general condition. Case 3 : a 53 year-old woman was sent for a suspect thyroid nodule. Radiological explorations showed diffuse metastases, except for adrenals ones. After surgery, the papillary TC was confirmed (stage T4N1M1, thyroglobulin=450ng/ml). Some months later a right adrenal mass appeared. That one did not fix radioiodine. The patient died 2 years later. Conclusion : The three observations seem worth to be reported for their rarity and for the possible association to adrenal insufficiency. That one may worsen the poor prognosis as adrenal metastases are observed in aggressive forms.