Massive Adrenal Metastasis

Abstract

A 66-year-old female former smoker of 40 pack/years presented with a cough accompanied by fever. Chest radiographs demonstrated a left lung mass. Computerized tomography of the chest and abdomen (Figure 1A) demonstrated a cavitated left lower lobe mass measuring 5.5 cm as well as bilateral adrenal masses each 5 cm in size (Figure 1B). Percutaneous needle biopsy of the right adrenal mass was positive for metastatic large-cell carcinoma of the lung. Serum cortisol level was normal. The patient was then referred to medical oncology and began treatment with carboplatin and taxol. Approximately 5 to 10% of patients have evidence of adrenal lesion(s) at the time of lung cancer presentation.1 In most cases, one adrenal lesion is found, but occasionally two or more are also evident. Other etiologies besides metastatic disease include adrenal adenomas, cystic changes, or adrenal hyperplasia. Previous population studies have shown that the overall incidence of benign adrenal lesions varies from 2 to 9%.2 Massive adrenal lesions are uncommon but have been reported. At the time of death, autopsy studies have shown that 25 to 40% of patients with lung cancer have findings of adrenal metastasis.