obsolete metastasis to adrenals

Metastases to the Adrenal Glands: A Rare but Noteworthy Occurrence

Metastases to the adrenal glands are a rare phenomenon, where cancer cells from other parts of the body spread to these vital organs. According to various studies [1][2][3], metastatic tumors in the adrenal glands are uncommon, with only 4 previously reported cases [4-7

Symptoms of Adrenal Metastasis

Adrenal metastasis, which refers to cancer that has spread to the adrenal glands, can manifest in various ways. While symptoms may not always be present, they can provide valuable clues for diagnosis.

• Pain: Large adrenal metastases, commonly found in lung cancer, can cause unilateral flank pain and, less frequently, abdominal pain [1].
• Abdominal or back discomfort: Sometimes, patients may experience symptoms related to the growth of their adrenal metastasis, such as abdominal or back discomfort [13].
• Adrenal insufficiency: Rarely, if both adrenal glands are involved with metastases, a patient may develop symptoms related to insufficient production of steroid hormones by the involved adrenal glands (adrenal insufficiency or Addisonian syndrome) [13].

Common Non-Endocrine Symptoms

In addition to these specific symptoms, patients with adrenal metastasis may also experience non-endocrine adverse effects, such as:

• Nausea and vomiting: Common side effects of mitotane treatment, which can overlap with signs of adrenal insufficiency [7].
• Fatigue: A common symptom in chronic primary adrenal failure and a possible side effect of mitotane treatment [3][7].

Important Considerations

It is essential to note that most patients with adrenal metastases will not experience symptoms related to endocrinological dysfunction, and therefore, these symptoms are not always present [2]. Additionally, metastatic disease to the adrenal glands is common but rarely causes hemorrhage [8].

References:

[1] Adrenal pain syndrome​​ Large adrenal metastases, common in lung cancer, may produce unilateral flank pain and, less commonly, abdominal pain. Pain is of ...

[2] Most patients with adrenal metastases will never experience symptoms related to endocrinological dysfunction and are therefore not recommended ...

[3] Common symptoms in chronic primary adrenal failure are weakness, fatigue, anorexia, and gastrointestinal symptoms like nausea and vomiting.

[7] by GAM Faulhaber · Cited by 10 — The major signs are weight loss, hyperpigmentation, and arterial hypotension. Usual laboratory abnormalities include hyponatremia and ...

[8] by AM Fowler · 2013 · Cited by 70 — Metastatic disease to the adrenal glands is common but rarely causes hemorrhage. Metastasis accounts for only 13% of reported hemorrhagic adrenal masses [17].

[13] Sometimes a patient will have symptoms related to the growth of their adrenal metastasis, for example abdominal or back discomfort. Rarely, if both adrenal glands are involved with metastases, a patient may develop symptoms related to insufficient production of steroid hormones by the involved adrenal glands (adrenal insufficiency or Addisonian ...

Diagnostic Tests for Obsolete Metastasis to Adrenals

Obtaining an accurate diagnosis of adrenal metastasis requires a combination of clinical evaluation, laboratory tests, and imaging studies.

• Laboratory Tests: Blood and urine tests can reveal unusual levels of hormones produced by the adrenal glands, including cortisol, aldosterone, and androgens [2]. These tests are essential in identifying the presence of adrenal tumors or metastases.
• Imaging Studies: CT, MRI, and PET scans are commonly used to visualize the adrenal glands and detect any growths or metastases. These imaging studies can help determine the extent of tumor spread and guide further treatment decisions [5].
• Biochemical Tests: Various biochemical tests can be performed after an adrenal mass is found, including tests for cortisol, aldosterone, and androgens. These tests can help determine if the adrenal mass is producing hormones and the extent of hormone production [13].

Specific Diagnostic Tests

The following diagnostic tests may be recommended to diagnose adrenal metastasis:

• CT (Computed Tomography) Scans: CT scans use X-ray technology to produce detailed images of the adrenal glands and surrounding tissues.
• MRI (Magnetic Resonance Imaging) Scans: MRI scans use magnetic fields and radio waves to produce detailed images of the adrenal glands and surrounding tissues.
• PET (Positron Emission Tomography) Scans: PET scans use a small amount of radioactive material to produce detailed images of the adrenal glands and surrounding tissues.

Other Diagnostic Tests

In some cases, additional diagnostic tests may be necessary to confirm the diagnosis of adrenal metastasis. These tests may include:

• FNA (Fine-Needle Aspiration) Biopsy: FNA biopsy is a minimally invasive procedure that involves using a fine needle to collect tissue samples from the adrenal gland.
• Blood and Urine Tests: Blood and urine tests can be used to measure levels of hormones produced by the adrenal glands.

References

[1] The adrenal glands are commonly infiltrated with metastases in patients with a variety of neoplastic diseases [4]. [2] Laboratory tests of your blood and urine may reveal unusual levels of hormones produced by the adrenal glands, including cortisol, aldosterone and androgens [2]. [3] Imaging tests can help determine the extent of tumor spread and guide further treatment decisions [5]. [4] The percentage of cancers which give metastases to the adrenal glands is about 42% for [4]. [5] Most adrenal metastasis are diagnosed using imaging studies such as CT, MRI, and PET scans [5].

Treatment Options for Adrenal Metastases

Adrenal metastases are a serious condition where cancer cells have spread to the adrenal glands. While there is no cure, various treatment options can help manage the disease and improve quality of life.

• Surgery: In some cases, surgery may be an option to remove the adrenal metastasis. However, this is typically only considered if the primary cancer has been treated and the adrenal metastasis is isolated.
• Chemotherapy: Chemotherapy is a common treatment for adrenal metastases. Medications like mitotane are often used to target the cancer cells in the adrenal glands [1][3]. Other chemotherapy drugs such as cisplatin, etoposide, and doxorubicin may also be used [9].
• Hormone therapy: For some types of adrenal cancer, hormone therapy may be an option. This involves taking medications that block the effects of hormones produced by the tumor.
• Targeted therapy: Targeted therapies such as cabozantinib combined with atezolizumab have shown promise in treating adrenal cortical cancer [8].

Important Considerations

It's essential to note that treatment for adrenal metastases often focuses on managing symptoms and improving quality of life rather than curing the disease. Treatment plans should be individualized based on the patient's overall health, the size and location of the tumor, and whether it has spread outside of the adrenal gland.

References:

[1] Adrenal metastases are primarily found on autopsy, but with increasing use of CT, MRI, and PET scans, they can now be detected before or during treatment for the underlying cancer [2].

[3] Mitotane is a pill taken 3 to 4 times a day that can also keep the other normal adrenal gland from producing steroid hormones [4].

[8] Adding cabozantinib to atezolizumab may be more effective at treating patients with adrenal cortical cancer than giving these drugs alone [8].

[9] Adjuvant or palliative treatment for adrenocortical carcinoma (AC) has been studied by using mitotane, cisplatin, etoposide, and doxorubicin [9].

The differential diagnosis of adrenal masses, including metastases, involves considering various primary and secondary entities that can affect the adrenal gland.

Common Causes of Adrenal Metastases

• Lung carcinoma is the most common cause of adrenal metastases [7].
• Other malignancies that commonly metastasize to the adrenal gland include renal cell carcinoma, melanoma, and lymphoma [6][7].

Differential Diagnosis of Adrenal Masses

The differential diagnosis of adrenal masses includes:

• Primary adrenal tumors (adenomas, carcinomas)
• Metastases from other cancers (lung, kidney, skin, etc.)
• Congenital adrenal hyperplasia
• Adrenocortical carcinoma

Key Considerations for Differential Diagnosis

When evaluating adrenal masses, it's essential to consider the following factors:

• Imaging characteristics: The appearance of the mass on imaging studies (CT, MRI, PET) can provide clues about its nature.
• Clinical presentation: Symptoms such as pain, weight loss, or hormonal imbalances can suggest a specific diagnosis.
• Laboratory findings: Blood tests and hormone level measurements can help identify potential causes.

References

For more information on the differential diagnosis of adrenal masses, including metastases, please refer to:

[1] Adrenal metastases are the most common malignant lesions involving the adrenal gland. [2] [6] Metastases to the adrenals have also been reported for renal cell carcinoma (5-15), hepatocellular carcinoma (16, 17), carcinoma of the bladder (18), lymphoma (19), and other malignancies. [7] Lung carcinoma is the most common adrenal metastasis; other malignancies that commonly metastasize to the adrenal are renal cell carcinoma, melanoma, and ... [9] In patients with bilateral adrenal masses, the differential diagnosis is somewhat shorter but includes metastases, congenital adrenal hyperplasia, and ...