Adrenal metastasis

Case contributed by Aoun Rizvi
Diagnosis almost certain


Severe hypotension on background of lung cancer.

Patient Data

Age: 60 years
Gender: Male



Significant metastatic disease in the adrenal glands causing an Addisonian-like crisis. The mesenteric arterial vasculature is unremarkable and there is no evidence of ischemic bowel. No bony metastases.


The patient needed ICU admission with vasopressor support and glucocorticoid adminisatration.

Case Discussion

  • In an autopsy series involving 464 patients with adrenal metastases, Lam and Lo found that the most common primary tumor site was the lung at 35% 1.
  • In a deteriorating patient with known metastatic cancer, acute adrenal insufficiency should be considered 3.
  • Left sided unilateral involvement of adrenal mets is more prevalent at 1.5:1 2, however there is bilateral involvement in this case.

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