Adrenal insufficiency due to bilateral adrenal metastases – A systematic review and meta-analysis

Tallis, Philippa H.; Rushworth, R. Louise; Torpy, David J.; Falhammar, Henrik

doi:10.1016/j.heliyon.2019.e01783

Cited by 30 publications

(38 citation statements)

References 33 publications

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“…The prevalence of adrenal insufficiency in bilateral adrenal metastasis is approximately 8%, which was calculated using strict inclusion criteria of documented bilateral disease and ACTH stimulation test for diagnosis (17). Secondary outcomes also demonstrated that 15% (3/20) of the cases were caused by breast cancer (17). Adrenal insufficiency should be considered as it may be the solitary sign of disease, as demonstrated in our patient.…”

Section: Discussionmentioning

confidence: 69%

“…A high index of suspicion is paramount in patients with a prior history of cancer presenting with hypotension, fatigue, nausea, vomiting, weakness, particularly in the setting of hyponatremia and normal to high potassium levels. The prevalence of adrenal insufficiency in bilateral adrenal metastasis is approximately 8%, which was calculated using strict inclusion criteria of documented bilateral disease and ACTH stimulation test for diagnosis (17). Secondary outcomes also demonstrated that 15% (3/20) of the cases were caused by breast cancer (17).…”

Section: Discussionmentioning

confidence: 99%

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Recurrent Invasive Ductal Breast Carcinoma Presenting as Primary Adrenal Insufficiency with Adrenal Crisis

Naik

Nestasie

Gordon

2020

AACE Clinical Case Reports

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Objective: We report the first case of recurrent ductal breast carcinoma presenting as primary adrenal insufficiency. Methods: We describe a patient who developed a recurrence of invasive ductal breast carcinoma which went undetected until the patient presented with fulminant adrenal crisis. We describe here an overview of the clinical presentation, work-up, diagnosis, and treatment of adrenal crisis. Results: Adrenal crisis due to bilateral adrenal metastases secondary to invasive ductal breast carcinoma is an exceedingly rare occurrence. To our knowledge, this is the first case of recurrent breast carcinoma in which the presenting feature is primary adrenal insufficiency. Conclusion: Patients with a history of breast carcinoma and bilateral adrenal enlargement should be evaluated for the presence of primary adrenal insufficiency.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Recurrent Invasive Ductal Breast Carcinoma Presenting as Primary Adrenal Insufficiency with Adrenal Crisis

Naik

Nestasie

Gordon

2020

AACE Clinical Case Reports

View full text Add to dashboard Cite

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“…The possible tumor-reducing effect of replacement therapy in one of our cases confused and delayed the diagnostics. Glucocorticoids are part of the standard regimen for several lymphoid cancers, due to steroid sensitivity of tumor cells that seems to be more pronounced for immature lymphoid cells (4). Glucocorticoids have direct actions on gene transcription through glucocorticoid response elements (GREs) and indirect actions through interaction with transcription factors.…”

Section: Discussionmentioning

confidence: 99%

Primary adrenal lymphoma as a cause of adrenal insufficiency, a report of two cases

Grønning

Sharma

Mastroianni

et al. 2020

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary Primary adrenal lymphoma (PAL) is a rare cause of adrenal insufficiency. More than 90% is of B-cell origin. The condition is bilateral in up to 75% of cases, with adrenal insufficiency in two of three patients. We report two cases of adrenal insufficiency presenting at the age of 70 and 79 years, respectively. Both patients had negative 21-hydroxylase antibodies with bilateral adrenal lesions on CT. Biopsy showed B-cell lymphoma. One of the patients experienced intermittent disease regression on replacement dosage of glucocorticoids. Learning points: Primary adrenal lymphoma (PAL) is a rare cause of adrenal insufficiency. Bilateral adrenal masses of unknown origin or in individuals with suspected extra-adrenal malignancy should be biopsied quickly when pheochromocytoma is excluded biochemically. Steroid treatment before biopsy may affect diagnosis. Adrenal insufficiency with negative 21-hydroxylase antibodies should be evaluated radiologically.

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“…While LAC rarely metastasizes to unusual locations, they most commonly do to the liver, adrenal glands and bones (3). Between 28 to 42% of LAC and approximately 30% of breast cancers metastasize to the adrenals (4). Adrenal insufficiency (AI), occurs in approximately 3 to 8% of individuals with bilateral adrenal metastases (5).…”

Section: Introductionmentioning

confidence: 99%

“…Adrenal insufficiency (AI), occurs in approximately 3 to 8% of individuals with bilateral adrenal metastases (5). AI was most commonly seen in bilateral adrenal metastases from LC (4).…”

Section: Introductionmentioning

confidence: 99%

Multiple endocrinological failures as a clinical presentation of a metastatic lung adenocarcinoma

Ach

Wojewoda

Toullet

et al. 2020

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary Multiple endocrine metastases are a rare but possible complication of lung adenocarcinoma (LAC). Pituitary metastasis is a rare condition with poor clinical expression. Diabetes insipidus (DI) is its most common presenting symptom. Here we report an original case of a pituitary stalk (PS) metastasis from LAC presenting as central DI followed by adrenal insufficiency (AI) from bilateral adrenal metastasis, without known evidence of the primary malignancy. A 45-year-old woman whose first clinical manifestations were polyuria and polydipsia was admitted. She was completely asymptomatic with no cough, no weight loss or anorexia. Chest radiography was normal. Brain MRI showed a thick pituitary stalk (PS). DI was confirmed by water restriction test and treated with vasopressin with great clinical results. Explorations for systemic and infectious disease were negative. Few months later, an acute AI led to discovering bilateral adrenal mass on abdominal CT. A suspicious 2.3 cm apical lung nodule was found later. Histopathological adrenal biopsy revealed an LAC. The patient received systemic chemotherapy with hormonal replacement for endocrinological failures by both vasopressin and hydrocortisone. We present this rare case of metastatic PS thickness arising from LAC associated with bilateral adrenal metastasis. Screening of patients with DI and stalk thickness for lung and breast cancer must be considered. Multiple endocrine failures as a diagnostic motive of LAC is a rare but possible circumstance. Learning points: Adrenal metastasis is a common location in lung adenocarcinoma; however, metastatic involvement of the pituitary stalk remains a rare occurrence, especially as a leading presentation to diagnose lung cancer. The posterior pituitary and the infundibulum are the preferential sites for metastases, as they receive direct arterial blood supply from hypophyseal arteries. Patients diagnosed with diabetes insipidus due to pituitary stalk thickness should be considered as a metastasis, after exclusion of the classical systemic and infectious diseases. The diagnosis of an endocrinological metastatic primary lung adenocarcinoma for patients without respiratory symptoms is often delayed due to a lack of correlation between endocrinological symptoms and lung cancer. The main originality of our case is the concomitant diagnosis of both endocrinological failures, as it was initiated with a diabetes insipidus and followed by an acute adrenal insufficiency.

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Adrenal insufficiency due to bilateral adrenal metastases – A systematic review and meta-analysis

Cited by 30 publications

References 33 publications

Recurrent Invasive Ductal Breast Carcinoma Presenting as Primary Adrenal Insufficiency with Adrenal Crisis

Recurrent Invasive Ductal Breast Carcinoma Presenting as Primary Adrenal Insufficiency with Adrenal Crisis

Primary adrenal lymphoma as a cause of adrenal insufficiency, a report of two cases

Multiple endocrinological failures as a clinical presentation of a metastatic lung adenocarcinoma

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