1
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Tallis PH, Rushworth RL, Torpy DJ, Falhammar H. Adrenal insufficiency due to bilateral adrenal metastases - A systematic review and meta-analysis. Heliyon 2019; 5:e01783. [PMID: 31193734 PMCID: PMC6541881 DOI: 10.1016/j.heliyon.2019.e01783] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 04/11/2019] [Accepted: 05/17/2019] [Indexed: 12/23/2022] Open
Abstract
Objective Bilateral adrenal metastases may cause adrenal insufficiency (AI) but it is unclear if screening for AI in patients with bilateral adrenal metastases is justified, despite the potential for adrenal crises. Method A search using PubMed/Medline, ScienceDirect and Cochrane Reviews was performed to collect all original research articles and all case reports from the past 50 years that describe AI in bilateral adrenal metastases. Results Twenty studies were included with 6 original research articles, 13 case reports and one case series. The quality was generally poor. The prevalence of AI was 3–8%. Of all cases of AI (n = 25) the mean pooled baseline cortisol was 318 ± 237 nmol/L and stimulated 423 ± 238 nmol/L. Hypotension was present in 69%, hyponatremia in 9% and hyperkalemia in 100%. Lung cancer was the cause in 35%, colorectal 20%, breast cancer 15% and lymphoma 10%. The size of the adrenal metastases was 5.5 ± 2.8 cm (left) and 5.5 ± 3.1 cm (right), respectively. There was no correlation between basal cortisol, stimulated cortisol concentration or ACTH with the size of adrenal metastases. The median time to death was 5.0 months (IQR 0.6–6.5). However, two cases were alive after 12–24 months. Conclusion The prevalence of AI in patients with bilateral adrenal metastases was low. Prognosis was very poor. Due to the low prevalence of AI, screening is likely only indicated in patients with symptoms and signs suggestive of hypocortisolism.
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Affiliation(s)
- Philippa H Tallis
- Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia.,Department of Medicine, Katherine Hospital, Katherine, NT, Australia
| | - R Louise Rushworth
- School of Medicine, Sydney, The University of Notre Dame, Darlinghurst, NSW, Australia
| | - David J Torpy
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.,University of Adelaide, Adelaide, SA, Australia
| | - Henrik Falhammar
- Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia.,Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.,Menzies School of Health Research, Darwin, NT, Australia
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2
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Guzzini F, Cozzi C, Cortese F, Gasparini P, Neri V, Pace L. Adrenal Failure Due to Bilateral Metastases as the Sole Manifestation of Relapsing Lung Carcinoma. Report of Two Cases. TUMORI JOURNAL 2018; 75:634-6. [PMID: 2559528 DOI: 10.1177/030089168907500625] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We describe two patients with lung carcinoma in whom adrenal glands were the sole site of tumor relapse, revealed by the appearance of Addison's disease. Both patients showed bilateral adrenal masses on US and/or CAT scans and received hormone replacement therapy, with rapid improvement of their general conditions. One of them, with small-cell carcinoma, could also be treated with further chemotherapy and achieved a second remission. Therefore, we stress that patients with lung carcinoma should be periodically screened for adrenal deposits by US or CAT and undergo prophylactic steroid maintenance whenever metastatic involvement of the glands is detected.
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Affiliation(s)
- F Guzzini
- U.S.S.L. 9 Divisione di Medicina II, Ospedale di Saronno, Varese, Italy
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3
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Abstract
The adrenals are a common site of metastases for lung cancers; adrenal insufficiency, however, as a presenting feature of lung cancer, is extremely rare. We report a case of primary adrenal insufficiency secondary to metastases from adenocarcinoma of the lung. Our patient presented with hypotension, abdominal pain, and weight loss. CT scans showed a right upper lobe mass and bilateral adrenal masses. The frequent occurrence of constitutional symptoms, metabolic derangements, and cardiovascular compromise in patients with advanced cancer may lead to an underestimation of the true incidence of adrenal insufficiency in this population.
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4
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Shantha GPS, Kumar AA, Jeyachandran V, Rajamanickam D, Bhaskar E, Paniker VK, Abraham G. Paraneoplastic (non-metastatic) adrenal insufficiency preceded the onset of primary lung cancer by 12 weeks. BMJ Case Rep 2009; 2009:bcr08.2008.0690. [PMID: 21686682 DOI: 10.1136/bcr.08.2008.0690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Clinically evident adrenal insufficiency associated with lung cancer is a rare entity. Among reported cases, adrenal insufficiency has occurred with or succeeded the primary lung cancer. Adrenal insufficiency has also been secondary to metastasis to the adrenal gland. The present report concerns a 61-year-old man, a chronic smoker, who presented to us with symptomatic adrenal insufficiency. He had no evidence of lung cancer during this visit. The primary lung cancer was only identified 12 weeks later. Additionally, his adrenals showed no evidence of metastasis. Hence his adrenal insufficiency had been a paraneoplastic manifestation of the lung cancer, and it had also preceded the primary by 12 weeks.
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Affiliation(s)
- Ghanshyam Palamaner Subash Shantha
- Sri Ramachandra University, General Medicine, Plot no. 70, Door no. 12, Kattabomman Street, Alwarthirunagar, Chennai, Tamilnadu, 600087, India
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5
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Bausewein C, Kühnbach R, Haberland B. Adrenal Insufficiency Caused by Bilateral Adrenal Metastases – a Rare Treatable Cause for Recurrent Nausea and Vomiting in Metastatic Breast Cancer. Oncol Res Treat 2006; 29:203-5. [PMID: 16679781 DOI: 10.1159/000092265] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nausea and vomiting are common symptoms in patients with malignant disease. Several, sometimes rare causes have to be considered to decide the right treatment. CASE REPORT We report of a patient suffering from advanced breast cancer and complaining of severe nausea and vomiting over several weeks without any successful treatment. Later on, she developed marked hyperpigmentation of the skin and hypo-osmolar dehydration. Adrenal enlargement was noted in an abdominal scan. The suspected diagnosis of primary adrenocortical insufficiency due to metastases was confirmed by laboratory tests. After replacement therapy with hydrocortisone and fludrocortisone, the general condition of the patient improved dramatically and the symptoms of nausea and vomiting disappeared completely. CONCLUSION If a patient with advanced cancer presents with unexplained and protracted nausea, vomiting and weakness, particularly if accompanied by hyponatremia and normal potassium levels, adrenal insufficiency due to adrenal metastases should be considered.
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Affiliation(s)
- Claudia Bausewein
- Interdisziplinäres Zentrum für Palliativmedizin, Klinikum der Universität München, Germany.
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6
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Kon YC, Sokoloff M, Straus FH, Weiss RE. Addisonian crisis and tuberculous epididymo-orchitis. Endocr Pract 2004; 8:365-9. [PMID: 15251839 DOI: 10.4158/ep.8.5.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe a case of acute primary adrenal insufficiency in which tuberculosis was subsequently detected as the etiologic factor when the patient presented with tuberculous epididymo-orchitis. METHODS A case of acute primary adrenal insufficiency associated with bilaterally enlarged adrenal glands is reported, along with the subsequent finding of a scrotal mass diagnosed as tuberculous epididymo-orchitis. Diagnosis, adrenal function, and results of imaging studies after institution of antituberculous treatment are discussed. RESULTS A 41-year-old Egyptian man, who had immigrated to the United States 5 years previously, had acute psychosis and addisonian crisis. A substantially increased early morning level of plasma adrenocorticotropic hormone and a low level of serum cortisol confirmed the diagnosis of primary adrenal insufficiency. Both adrenal glands were enlarged but without calcification on computed tomography. A previous bacille Calmette-Guérin vaccination complicated the interpretation of a positive tuberculin skin test result. Both lungs were clear on chest radiography and computed tomography. Seven months later, the patient had a left scrotal mass and underwent radical orchiectomy. Examination of the pathology specimen showed caseous granulomatous inflammation and necrosis, and acid-fast bacilli were identified. Culture was positive for Mycobacterium tuberculosis. CONCLUSION In a patient from a country where tuberculosis is endemic, tuberculosis should be considered in the differential diagnosis when primary adrenal insufficiency is detected, especially in association with enlarged or calcified adrenal glands. Extra-adrenal tuberculous involvement should be actively sought because it may provide indirect microbiologic or histologic clues. Other than the lungs, special attention should be paid to the genitourinary system.
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Affiliation(s)
- Yin Chian Kon
- Department of Medicine, University of Chicago, Illinois 60637, USA
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7
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Yamashita S, Machado JM, Morceli J. Emprego da tomografia computadorizada na detecção de alterações das adrenais em doentes com tuberculose. Radiol Bras 2004. [DOI: 10.1590/s0100-39842004000300006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Neste estudo foram avaliadas, por meio de tomografia computadorizada, as adrenais em indivíduos sem tuberculose (grupo 1 - G1) e com tuberculose (grupo 2 - G2). A dimensão ântero-posterior, a espessura e o comprimento das adrenais foram comparados no G1 e no G2. Foram também avaliadas a duração da doença com a ocorrência de alteração morfológica no G2, e a distribuição segundo o sexo, a idade e a cor da pele no G1 e no G2. Neste estudo houve diferença nas dimensões ântero-posterior e espessura da adrenal direita entre o G1 e o G2. Observou-se maior ocorrência do sexo masculino e de indivíduos de pele branca no G2. Não houve associação entre a duração da doença e a ocorrência de alteração morfológica no G2. Maior ocorrência da alteração morfológica tipo alargamento foi observada no G2. Os principais achados pela tomografia computadorizada, nos pacientes com tuberculose, foram alargamento da adrenal sem calcificação, alargamento da adrenal com calcificação puntiforme e calcificação de aspecto residual da adrenal.
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8
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Rodado Marina S, Aguirre Sánchez-Covisa M, García Vicente AM, Poblete García VM, Ruiz Solís S, Cortés Romera M, Soriano Castrejón A. [Contribution of the scintigraphy with iodocholesterol (I-COL) to the diagnosis and characterization of silent adrenal masses]. ACTA ACUST UNITED AC 2004; 23:166-73. [PMID: 15153359 DOI: 10.1016/s0212-6982(04)72277-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the role of the adrenal cortical scintigraphy with 131-I Norcholesterol (I-COL) in the diagnosis and characterization of silent adrenal masses. METHODS We selected 57 patients who underwent an adrenal scintigraphy with I-COL, 36 women and 21 men (mean aged: 62.5 years), and who were classified into two groups: Group I or Incidentalomas, 39 patients without signs or symptoms of adrenal disease in whom an adrenal mass is incidentally discovered during a CT or ultrasound scan; and a second group or Group II, 18 patients with history of cancer in whom an adrenal mass is discovered. We defined the following Scintigraphic patterns in relationship with the CT: Normal, concordant unilateral (CU) or exclusive; discordant unilateral (DU); concordant asymmetrical (CA) or prevalent; discordant asymmetrical (DA) and nonvisualization (NV). The final diagnosis was obtained with clinical, analytical, and radiological evaluation and in some cases surgery. RESULTS In Group I, the diagnoses were: 17 adrenal masses without criteria of malignancy or hormonal overproduction (the Scintigraphic patterns were 10 CA, 5 normal and 2 CU), 9 Subclinical Cushing's syndrome (4 CU, 4 CA and 1 normal), 5 adenomas (all CU), 3 adrenal primary carcinomas, with no uptake in the scintigraphy, and 5 were other diagnoses. In group II, 14 patients had benign masses (all patterns were normal or concordant) and 4 patients metastases (3 discordant and 1 NV patterns). The follow-up time was at least one year. CONCLUSIONS The adrenal cortical scintigraphy with I-COL provides us information on the functional status of silent adrenal masses and it is an useful tool to distinguish benign from malignant lesions; for this reason we considered that it must be integrated in the diagnostic algorithm as a complement to other techniques.
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Affiliation(s)
- S Rodado Marina
- Servicio de Medicina Nuclear, Hospital Nuestra Señora de Alarcos, Ciudad Real, Spain
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9
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Sirachainan E, Kalemkerian GP. Unusual presentations of lung cancer: Case 2. Adrenal insufficiency as the initial manifestation of non-small-cell lung cancer. J Clin Oncol 2002; 20:4598-600. [PMID: 12454119 DOI: 10.1200/jco.2002.20.23.4598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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10
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Abstract
BACKGROUND The widespread use of abdominal imaging has led to increased detection of adrenal tumors. The significance of these masses, as well as the optimal management approach to treatment, has generated some controversy regarding further evaluation and therapy. METHODS The authors reviewed the literature regarding the evaluation and management of these masses, particularly adrenal incidentalomas. Based on their institutional experience, they propose a diagnostic, evaluation, and management algorithm for treating adrenal masses. RESULTS Appearance and clinical history should indicate how to perform the biochemical evaluation, keeping in mind that the presence of pheochromocytomas must be ruled out. Radiological evaluation by CT or MRI provides useful parameters to identify malignant lesions. Surgery is indicated for masses that are larger than 5 cm in diameter or suspected of malignancy. Fine-needle aspiration biopsy should be used when other extra-adrenal malignancies are suspected and after pheochromocytoma has been ruled out. CONCLUSIONS Careful analysis of each adrenal mass is essential to effectively avoid potential problems. Guidelines to manage patients with adrenal masses are needed.
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Affiliation(s)
- Sergio G Moreira
- Department of Surgery, University of South Florida, Tampa, 33612, USA
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11
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Davì MV, Francia G, Brazzarola P, Olivieri M, Petrozziello A, Orsolini A, Petronio R, Sussi PL. An unusual case of adrenal failure due to isolated metastases of breast cancer. J Endocrinol Invest 1996; 19:488-9. [PMID: 8884545 DOI: 10.1007/bf03349896] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We describe a patient affected by adrenal insufficiency due to metastases of breast cancer. Adrenal involvement became clinically evident 20 years after radical mastectomy and it was the only secondary localization of the tumor. There is still no evidence of other metastases after a two year follow-up. This case suggests that adrenal function evaluation should be included in periodical follow-ups of patients who underwent radical mastectomy for breast cancer.
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Affiliation(s)
- M V Davì
- Istituto di Semeiotica e Nefrologia Medica, Cattedra di Endocrinochirurgia, Università di Verona, Italy
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12
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Miller M, Gold GC. Acute Endocrine Emergencies. Clin Geriatr Med 1994. [DOI: 10.1016/s0749-0690(18)30365-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Messiant F, Duverger D, Verheyde I, Declerck N, Pruvot FR, Scherpereel P. [Postoperative acute adrenal insufficiency]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1993; 12:594-7. [PMID: 8017676 DOI: 10.1016/s0750-7658(05)80629-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Acute adrenal insufficiency is an uncommon complication of lung cancer and adrenal metastasis resection. Diagnosis is difficult to establish but an early recognition and treatment may be life-saving. A 55-year-old man underwent right upper lobectomy and adrenalectomy for lung carcinoma with right adrenal metastasis. Anaesthesia was obtained with propofol, alfentanil, atracurium and isoflurane. Blood pressure remained stable throughout surgical procedure and blood loss was about 3,000 ml. Several hours after the end of the procedure which was uneventful the circulator status worsened. The blood pressure was initially controlled with 500 ml of gelatin. External blood loss was about 200 ml. Clinical examination, chest X-ray and ECG were normal. Postoperative laboratory data showed a serum sodium at 134 mmol-1.l-1 and a serum potassium 5.1 mmol.l-1; haemoglobin concentration was 93 g.l-1. Arterial blood gas analysis, with a 5.1.min-1 nasal O2 flow showed a PaO2 at 108 mmHg, a PaCO2 at 30 mmHg and a pH at 7.44. Twelve hours later, a transient cardiac arrest occurred which responded to fluid load, dopamine and dobutamine. Six hours later, the patient went in ventricular fibrillation responding to an external electric countershock. No change in clinical status was noticed, except hyperthermia at 39.5% degrees C. Serum potassium concentration before cardiac arrest was 4.7 mmol-l-1. Main considered diagnoses were septic shock and acute adrenal insufficiency. Antibiotics (imipenem, amikacin and vancomycin) and hormonal treatment (hydrocortisone 200 mg.day-1), after blood samples had been obtained for bacteriological and hormonal examinations. The patient's condition improved dramatically within 48 hours. Shock was under control, dopamine and dobutamine were rapidly discontinued.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- F Messiant
- Departement d'Anesthésie-Réanimation Chirurgicale 2, CHU, Hôpital Claude-Huriez, Lille
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14
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Khafagi FA, Gross MD, Shapiro B, Glazer GM, Francis I, Thompson NW. Clinical significance of the large adrenal mass. Br J Surg 1991; 78:828-33. [PMID: 1873713 DOI: 10.1002/bjs.1800780720] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Current clinical teaching indicates that large (greater than 5 cm in diameter) adrenal masses are often malignant. In a retrospective analysis of patients studied between 1977 and 1988 with computed tomography (CT), adrenal scintigraphy, and when available, magnetic resonance imaging (MRI) 45 were found to have adrenal masses greater than 5 cm (range 5-19 cm) in diameter. Thirty were benign (16 phaeochromocytomas, six adrenocortical adenomas, four adrenal cysts, two myelolipomas, an adrenal hematoma and a ganglioneuroma). Of 15 malignant masses, there were seven adrenocortical carcinomas, five adrenal metastases and three adrenal lymphomas. With the exception of the adrenal myelolipomas, cysts, and the ganglioneuroma neither CT nor MRI demonstrated sufficient diagnostic specificity to distinguish benign from malignant lesions. Functional scintigraphy with 131I-6-beta-iodomethyl-19-norcholesterol for suspected adrenocortical lesions and 131I-metaiodobenzylguanidine for suspected phaeochromocytomas frequently provided useful information.
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Affiliation(s)
- F A Khafagi
- Department of Internal Medicine, University of Michigan, Ann Arbor
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15
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Ihde JK, Turnbull AD, Bajorunas DR. Adrenal insufficiency in the cancer patient: implications for the surgeon. Br J Surg 1990; 77:1335-7. [PMID: 2276011 DOI: 10.1002/bjs.1800771206] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Aspects of acute and chronic adrenal insufficiency of interest to surgeons who treat cancer patients are reviewed. Clinical features and the management of both primary and secondary types are considered with reference to classification, aetiology, diagnosis and treatment. Specifically considered are the management of patients with Addison's disease and metastases. Prompt recognition and treatment of adrenal insufficiency can avert potentially life-threatening situations.
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Affiliation(s)
- J K Ihde
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021
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16
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Taylor HC, Shah B, Pillay I, Mayes DM. Isolated hyperreninemic hypoaldosteronism due to carcinoma metastatic to the adrenal gland. Am J Med 1988; 85:441-4. [PMID: 3414740 DOI: 10.1016/0002-9343(88)90605-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- H C Taylor
- Division of Endocrinology, Case Western Reserve University School of Medicine, Lutheran Medical Center, Cleveland, Ohio 44113
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17
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Fujita K, Kameyama S, Kawamura M. Surgically removed adrenal metastasis from cancer of the rectum. Report of a case. Dis Colon Rectum 1988; 31:141-3. [PMID: 3338346 DOI: 10.1007/bf02562648] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A woman was operated on for pulmonary metastasis four years after a radical resection of the rectum, and four years thereafter a solitary metastasis to the left adrenal was found. An elevated serum carcinoembryonic antigen (CEA) level indicated the lesion. Adrenalectomy was performed and the patient has been well with no further evidence of disease.
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Affiliation(s)
- K Fujita
- National Medical Center Hospital, Tokyo, Japan
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18
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Abstract
Fifteen consecutive patients with metastatic carcinoma who demonstrated bilateral adrenal metastasis on abdominal computed tomography (CT) were evaluated by the cosyntropin challenge test. Primary sites of tumors included lung, ten; colon, two; gastric, one; ovarian, one; and unknown primary, one. Bilateral adrenal enlargement was defined as greater than 1 cm on CT scan. Adrenal insufficiency was defined as a failure to increase serum cortisol by at least 5 micrograms/100 ml to a minimum of 15 micrograms/100 ml at either 30 or 60 minutes postcosyntropin. No patient had previously been on corticosteroids. All patients were questioned and examined for symptoms/signs of adrenal insufficiency. Five patients (33%) were found to have adrenal insufficiency based on the cosyntropin test. Of the clinical parameters evaluated, all five patients had nausea, anorexia, and orthostatic hypotension. The clinical onset of adrenal insufficiency was insidious; no patient experienced acute adrenal crisis. We conclude that adrenal insufficiency is not a rare occurrence in patients with metastatic cancer and bilateral adrenal involvement on CT scan.
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19
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Kennedy RL, Ball RY, Dixon AK, ApSimon AT. Metastatic transitional cell carcinoma of the bladder causing Addison's disease. J Urol 1987; 137:986-8. [PMID: 3573205 DOI: 10.1016/s0022-5347(17)44324-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Addison's disease is rarely caused by metastatic cancer. We report a unique case of hypoadrenalism owing to metastatic transitional cell carcinoma of the bladder. The relevant literature is reviewed.
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