Abstract
A 56-yr-old man was admitted to our university hospital for severe back pain one month after a resection for lung adenocarcinoma (stage IIIA) without evidence of the adrenal mass. Computed tomography (CT) of the abdomen showed bilateral bleeding of adrenal tumors. Endocrinological laboratory studies showed high plasma ACTH and normal serum cortisol levels with the loss of circadian rhythm. Although plasma ACTH levels increased, there was no cortisol response to administration of human corticotropichormone (hCRH). Core-needle biopsy was performed on the right adrenal tumor and revealed adenocarcinoma cells mimicking a primary lung tumor previously examined. We diagnosed retroperitoneal hemorrhage due to bilateral adrenal gland metastasis from lung adenocarcinoma with adrenal insufficiency. Adrenal metastases most commonly originate from a primary lung tumor, followed by stomach, esophagus and liver/bile ducts. Bilateral adrenal metastases were noted in approximately half of all adrenal metastases patients. Clinically significant adrenal hemorrhage by metastasis is exceedingly rare and non-specific symptoms, such as abdominal, chest or back pain, nausea and vomiting, confusion, weakness, hypotension, shock and high fever, are often observed in these patients. We present a case of massive retroperitoneal hemorrhage and adrenal insufficiency due to adrenal gland metastasis from adenocarcinoma of lung.
Similar content being viewed by others
References
Hara N, Takano K, Inoshima N. Epidemiological trends in Japanese lung cancer. Nippon Rinsho 2002, 60(Suppl 5): 29–34 (in Japanese).
Schottenfield D. Etiology and epidemiology of lung cancer. In: Pass HI, Mitchell JB, Johnson DH, et al. eds. Lung Cancer Principles and Practice. Philadelphia: Lippincott Williams and Wilkins. 1994, 367–88.
Peppercorn PD, Grossman AB, Rezneck RH. Imaging of incidentally discovered adrenal masses. Clin Endocrinol (Oxf) 1988, 48: 379–88.
Glazer HS, Weyman PJ, Sagel SS, Levitt RG, McClennan BL. Nonfunctioning adrenal masses: incidental discovery on computed tomography. AJR Am J Roengtenol 1982, 139: 81–5.
Mantero F, Terzolo M, Arnaldi A, et al, and on behalf of the Study Group on Adrenal Tumors of the Italian Society of Endocrinology. A survey on adrenal incidentaloma in Italy. J Clin Endocrinol Metab 2000, 85: 637–44.
Quint LE, Tummala S, Brisson LJ, et al. Distribution of distant metastases from newly diagnosed non-small cell lung cancer. Ann Thorac Surg 1996, 62: 246–50.
Lam KY, Lo CY. Metastatic tumors of the adrenal glands: a 30-year experimence in a teaching hospital. Clin Endocrinol(Oxf) 2002, 56: 95–101.
Higashiyama M, Doi O, Kodama K, Yokouchi H, Imaoka S, Koyama H. Surgical treatment of adrenal metastasis following pulmonary resection for lung cancer: Comparison of adrenalectomy with palliative therapy. Int Surg 1994, 79: 124–9.
Lenert JT, Barnett CC Jr, Kudelka AP, et al. Evaluation and surgical resection of adrenal masses in patients with a history of extra-adrenal malignancy. Surgery 2001, 130: 1060–7.
Rao RH. Bilateral massive adrenal hemorrhage. Med Clin North Am 1995, 79: 107–29.
Botteri A, Orell SR. Adrenal hemorrhage and necrosis in the adult, a clinicopathological study of 23 cases. Acta Med Scand 1964, 175: 409–19.
Herbst RS, Fidler IJ. Angiogenesis and lung cancer: potential for therapy. Clin Cancer Res 2000, 6: 4604–6.
Lutz A, Stojkovic M, Schmidt M, Arlt W, Allolio B, Reincke M. Adrenocortical function in patients with macrometastases of the adrenal gland. Eur J Endocrinol 2000, 143: 91–7.
Abdel-Raheem MM, Potti A, Becker WA, et al. Late adrenal metastasis in operable non-small cell lung carcinoma. Am J Clin Oncol 2002, 25: 81–3.
Luketich JD, Burt ME. Dose resection of adrenal metastases from non-small cell lung cancer improve survival? Ann Thorac Surg 1996, 62: 1614–20
Miyaji N, Miki T, Shimada J, Takeshita T, Churei H, Nakajo M. Radiotherapy for adrenal gland metastasis from lung cancer: Report of three cases. Radiat Med 1999, 17: 71–5.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hiroi, N., Yanagisawa, R., Yoshida-Hiroi, M. et al. Retroperitoneal hemorrhage due to bilateral adrenal metastases from lung adenocarcinoma. J Endocrinol Invest 29, 551–554 (2006). https://doi.org/10.1007/BF03344146
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03344146