Case 2 - Adrenal Mass in a Patient With a History of Extraadrenal Malignancy: The Role of Imaging

Abstract

Adrenal metastasis should be suspected in any patient with a history of extraadrenal malignancy presenting with an indeterminate adrenal mass. Full hormonal workup and assessment of imaging characteristics are important even when the likelihood of adrenal metastasis is high. Pheochromocytoma presents with similar indeterminate adrenal imaging, and, if mistaken for an adrenal metastasis, a biopsy can be inadvertently performed, resulting in potentially severe side effects. Imaging characteristics of the adrenal mass can help exclude malignancy (as in lipid-rich tumors), and avoid additional testing, such as adrenal biopsy. Finally, finding adrenal hormonal excess such as cortisol, androgen, or aldosterone excess can help diagnose an adrenocortical adenoma or carcinoma and exclude other etiologies of adrenal tumors that are incapable of steroid production.