Severe hypotension on background of lung cancer.
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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.
1 case question available
- 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.
- 1. Lam, K.-Y., & Lo, C.-Y. (2002). Metastatic tumours of the adrenal glands: a 30-year experience in a teaching hospital. Clinical Endocrinology, 56(1), 95–101. doi: 10.1046/j.0300-0664.2001.01435.x
- 2. El-Feky, M., & Weerakkody, Y. (n.d.). Adrenal metastases: Radiology Reference Article. Retrieved June 4, 2020, from https://radiopaedia.org/articles/adrenal-metastases?lang=gb
- 3. Jameson, J., & De Groot, L. (2016). p1772. Endocrinology. Philadelphia: Elsevier Saunders.