Bilateral Adrenal Metastasis Presenting as Adrenal Insufficiency.

Abstract

The adrenal glands are the fourth most common site of distant metastasis after lung,liver and bone. The incidence of adrenal metastasis is high in bronchogenic and breast carcinoma.On the other hand clinical adrenal de ficiency due to metastasis is very rare 1 .In patients with cancer, adrenal insu fficiency may go unrecognized because the symptoms such as weakness, anorexia,nausea,vomiting ,orthostatic hypotension, electrolyte abnormalities are nonspecific and may be attributed to the underlying progressive malignancy. Moreover, terminal stage cancer patients can have symptoms that overlap with symptoms of adrenal insuffciency.We here report a case of 80 year old male, nonsmoker who presented with loss of more than 25 kg body weight in a span of two months. His plain x-ray chest was normal but computed tomography of abdomen revealed incidental bilateral large adrenal masses.His haematological and biochemical tests revealed no significant abnormality except low plasma protein and low albumen.Hormonal examination for assessment of corti-sol status confirmed primary adrenal insufficiency.PET-CT revealed the primary site to be in lungs.