Spontaneous tumor lysis syndrome in adrenal adenocarcinoma: a case report and review of the literature

Abstract

Background Tumor lysis syndrome is an oncologic emergency that classically occurs following cancer therapy, although spontaneous tumor lysis syndrome can also occur in malignancies, albeit rarely. Spontaneous tumor lysis syndrome has previously been reported in some hematologic malignancies, but it rarely happens in solid tumors and seems to be associated with a higher mortality rate. This is the first case of adrenal adenocarcinoma that developed spontaneous tumor lysis syndrome. Case presentation We present a rare case of spontaneous tumor lysis syndrome occurring in a patient previously diagnosed with adrenal adenocarcinoma. The patient was a 64-year-old Persian man with abdominal pain, hypersomnia, and fatigue who was previously diagnosed with right adrenocortical carcinoma and had undergone right adrenalectomy with regional lymph nodes resection 5 months previously. On physical examination, the patient had abdominal distension and mild tenderness at the right upper quadrant. Pitting edema was detected bilaterally in the lower extremities. Initial imaging revealed multiple and large lesions suggestive of liver metastases. The laboratory data showed hyperkalemia, hyperuricemia, hyperphosphatemia, and elevated serum creatinine level indicative of spontaneous tumor lysis syndrome in the patient. Despite immediate and intensive care with antibiotics, hydration, treatment with a hypouricemic agent, and renal replacement therapy, the patient ultimately died from multiorgan failure. Conclusions Tumor lysis syndrome in solid tumors has high mortality. Patients susceptible to spontaneous tumor lysis syndrome must receive aggressive treatment immediately, which is crucial for preventing morbidity and mortality. Spontaneous tumor lysis syndrome may be underdiagnosed, and a high degree of clinical suspicion is needed to make the diagnosis and proceed with required interventions. Therefore, clinicians should be aware of this rare phenomenon.

Burkitt lymphoma presenting as cecum mass and spontaneous tumor lysis syndrome with hypercalcemia

“…However, patients under treatment for hematologic malignancies, mainly BL and ALL, are at the highest risk for developing TLS. 15 Based on existing literature, certain intrinsic tumorrelated factors have been associated with an increased risk of developing TLS, such as high tumor cell proliferation rate, significant tumor burden, tumor chemosensitivity, and increased LDH levels, which were all seen in our case. Furthermore, it has been suggested that certain conditions, including preexisting uremia or hyperuricemia, decreased urinary flow or acidic urine, dehydration, oliguria, anuria, and renal insufficiency or renal failure may predispose patients to develop TLS, which was also observed in our case.…”

Plasma cell leukemia presenting as spontaneous tumor lysis syndrome with hypercalcemia

“…Hypouricemic agents such as allopurinol and rasburicase can be helpful in lowering serum uric acid levels. If the above measures are not effective and the following conditions are met, hemodialysis will be indicated in a case with severe oliguria or anuria, persistent hyperkalemia, hyperphosphatemia induced symptomatic hypocalcemia, and calcium phosphate product ≥70 mg/dl 14 …”

“…The patient was initially suspected of having tuberculosis and treatment was started, but because he was not relieved, he was referred to another center for further investigation. Our literature review suggested that although STLS has a worse prognosis in some cases, due to the poor prognosis of TLS in malignancies, particularly STLS, it is essential to consider the fact that TLS can occur spontaneously and it is important to initiate immediate treatment as any suspicious symptoms are noticed 14 . Meanwhile, PCL is an aggressive malignancy, and the overall prognosis of PCL is very poor with a median survival of 7–11 months, with up to 28% dying within the first month after diagnosis.…”

“…Our literature review suggested that although STLS has a worse prognosis in some cases, due to the poor prognosis of TLS in malignancies, particularly STLS, it is essential to consider the fact that TLS can occur spontaneously and it is important to initiate immediate treatment as any suspicious symptoms are noticed. 14 Meanwhile, PCL is an aggressive malignancy, and the overall prognosis of PCL is very poor with a median survival of 7-11 months, with up to 28% dying within the first month after diagnosis. It is even shorter when PCL occurs simultaneously with complications such as TLS.…”

“…If the above measures are not effective and the following conditions are met, hemodialysis will be indicated in a case with severe oliguria or anuria, persistent hyperkalemia, hyperphosphatemia induced symptomatic hypocalcemia, and calcium phosphate product ≥70 mg/dl. 14 According to literature, a number of hematologic and solid malignancies have been reported developing STLS as a first presentation of the disease. Only one case of PCL developing into STLS has been reported so far.…”