Page 25 - Delaware Medical Journal - October 2017
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CASE REPORT
after detection of primary tumor.2 Unlike the other six case reports, both of our patients were found to have hypo adrenalism. History and physical exam made us highly suspicious for adrenal and CT scan being obtained. Etiology of Acting on clinical suspicion can lead to prompt diagnosis and treatment.
The current literature suggests that treatment of solitary adrenal metastasis from sources such as lung cancer with adrenalectomy may increase survival. This treatment has been applied to other cases of metastasis including IDC; sometimes along with additional systemic therapy. Given the rarity however there are not randomized studies that support effectiveness of adrenalectomy in long term survival.1 In the six reported cases of isolated breast cancer in the literature, all patients underwent adrenalectomy.
In regards to treatment for adrenal
treatment with corticosteroids. The literature supports that replacement 4
with short acting glucocorticoids such as hydrocortisone in divided doses such as the treatment we choose for patient number one. Most patients will also eventually require mineralocorticoid replacement in order to prevent volume depletion, sodium loss and hyperkalemia. Patient number
two is currently being managed with the mineralocorticoid Fludrocortisone. Despite tumor regression, both patients continue to
REFERENCES
FIGURE 5
Patient #2 CT abdomen and Pelvis showing regression of adrenal enlargement and stable calcifications in 2010.
CONCLUSION
Adrenal metastasis as a cause of adrenal
considered in a patient with a history of breast cancer, even after 15 years without disease. Combination of CT adrenalectomy may be considered
for patients with isolated adrenal metastasis. Patients with certain tumors and pathologic features may do well, with limited toxicities from targeted systemic treatments. Those with adrenal corticosteroid replacement regardless of tumor regression.4
CONTRIBUTING AUTHORS
■ TRISHA PASCALL-LOPEZ, DO is an Internal Medicine Resident at Christiana Care Health System in Newark, Del.
■ MICHAEL J. GUARINO, MD is a Medical Oncologist at the Helen F. Graham Cancer Center and Research Institute at Christiana Care Health System in Newark, Del.
■ DAVID D. BIGGS, MD is a Medical Oncologist at the Helen F. Graham Cancer Center and Research Institute at Christiana Care Health System in Newark, Del.
■ RANDI LAPOINT, MD is a Cytopathologist at Christiana Care Health System in Newark, Del.
■ JAMES HAYS, MD is an Endocrinologist at Christiana Care Health System in Newark, Del.
1. Liu XL, Shen P, Wang X, et al. Solitary adrenal metastasis from invasive ductal breast cancer: an uncommon finding. World J Surg Oncol. 2010;8:7.
2. Lam KY, Lo CY. Metastatic tumors of the adrenal glands: a 30 year experience in a teaching hospital. Clin Endocrinol (Oxf). 2002;56:95-101.
3. He T, Liu J, Jin L, et al. Left adrenal gland metastasis of breast invasive ductal carcinoma: A case report. Mol Clin Oncol. 2016;4:859-862.
4. Nieman LK, Lacroix A, Martin KA. Treatment of adrenal insufficiency in adults. UpToDate [Internet]. Available from: http://www.uptodate.com/contents/ treatment-of-adrenal-insufficiency-in-adults. Accessed March 3, 2017.
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