Retroperitoneal hemorrhage due to bilateral adrenal metastases from lung adenocarcinoma

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.

Adrenal Artery Embolization: Anatomy, Indications, and Technical Considerations

“…We found 19 reports involving 25 patients in the English literature [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44]. The most frequent site of primary tumors resulting in hemorrhagic adrenal metastases is the lung [26,[29][30][31][32][33][34][35][36][37][38][39][42][43][44]. Other primary malignancies include two cases of hepatocellular carcinoma, one case of hepatic angiosarcoma, one case of hepatic hemangioendotheliosarcoma, and two cases of melanoma [27,28,31,40,41].…”

Adrenal Insufficiency Associated with Small Cell Lung Cancer: A Case Report and Literature Review

“…Lam et al reported that only three of 421(0.7%) cases with metastasis adrenal tumors by carcinomas had clinical findings and endocrinological evidence of Addisonʼs disease by metastasis of lung adenocarcinoma [4]. In the reports of 22 cases which were able to evaluate clinical characteristics and outcome in the English and Japanese literature search which we performed since 1980 [8,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29], 19 cases had adrenal insufficiency associated with NSCLC (the pathological type of lung cancer was unknown in one case) and most of them were adenocarcinoma (Table 2). On the other hand, only two cases of adrenal insufficiency associated with SCLC have been previously reported; one was diagnosed by a low serum cortisol level (≦ 2.5 µg/dl) with an elevation of ACTH (241 pg/ml) [23], while the other was diagnosed by a low serum cortisol level (3.0 µg/ml) [16].…”

Spontaneous adrenal hemorrhage during pregnancy: review of literature and case report of successful conservative management

“…Unilateral adrenal hemorrhage occurs in 2% of patients with penetrating trauma (1), whereas right adrenal hemorrhage is reported in 2% of liver transplant patients. Hemorrhagic tumor infarction due to primary or metastatic tumors can cause unilateral adrenal hemorrhage (3,6). Isolated case reports in association with long term non-steroidal anti-inflammatory drug use in uncomplicated pregnancy and neurofibromatosis have been reported.…”