Adrenocortical function in patients with macrometastases of the adrenal gland

Lutz, A.M.; Stojković, Mirjana; Schmidt, Marjanka K.; Arlt, Wiebke; Allolio, Bruno; Reincke, Martín

doi:10.1530/eje.0.1430091

Cited by 42 publications

(32 citation statements)

References 32 publications

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“…2,3 Of note, metastasis to the adrenal glands rarely causes adrenal insufficiency, and occurs only if metastatic disease is bilateral, with extensive damage to the adrenal glands. 4 Without adequate steroid replacement therapy, this was an invariably fatal condition in the time of Addison, with almost all patients dying within the initial 5 years of diagnosis. The discovery of cortisone by Hench, Kendall, and Reichstein in the late 1940s improved the outlook on patients with adrenal insufficiency dramatically, and initial data suggested that life expectancy was normalized.…”

Section: Definition and Epidemiologymentioning

confidence: 99%

Adrenal Crisis: Still a Deadly Event in the 21st Century

Puar

Stikkelbroeck

Smans

et al. 2016

The American Journal of Medicine

145

140

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Adrenal crisis is a life-threatening medical emergency, associated with a high mortality unless it is appropriately recognized and early treatment is rendered. Despite it being a treatable condition for almost 70 years, failure of adequate preventive measures or delayed treatment has often led to unnecessary deaths. Gastrointestinal illness is the most common precipitant for an adrenal crisis. Although most patients are educated about "sick day rules," patients, and physicians too, are often reluctant to increase their glucocorticoid doses or switch to parenteral injections, and thereby fail to avert the rapid deterioration of the patients' condition. Therefore, more can be done to prevent an adrenal crisis, as well as to ensure that adequate acute medical care is instituted after a crisis has occurred. There is generally a paucity of studies on adrenal crisis. Hence, we will review the current literature, while also focusing on the incidence, presentation, treatment, prevention strategies, and latest recommendations in terms of steroid dosing in stress situations.

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Section: Definition and Epidemiologymentioning

confidence: 99%

Adrenal Crisis: Still a Deadly Event in the 21st Century

Puar

Stikkelbroeck

Smans

et al. 2016

The American Journal of Medicine

145

140

View full text Add to dashboard Cite

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“…Even in two cases of large bilateral metastases, there was no adrenal insufficiency in these patients. Adrenal insufficiency, a state which is often suspected in cases of metastases to both adrenal glands, is in fact a rare symptom in such patients [24].…”

Section: Prace Oryginalnementioning

confidence: 99%

Adrenal tumour bigger than 5 cm — what could it be? An analysis of 139 cases

Cichocki

Samsel

Papierska

et al. 2017

Endokrynologia Polska

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Introduction: There is an increasing number of adrenal being tumours discovered incidentally during imaging examinations performed for many different indications. Radiological findings suggesting adrenal pathology may be caused by true adrenal tumours or by other retroperitoneal masses. Generally, the larger the tumour, the higher the possibility of adrenal cancer. Material and methods: Analysis of our data -139 operations performed over 11 years (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014) in patients with tumours in the adrenal area larger than 5 cm. Results: The most common finding was adrenal cancer (25.2%), benign adenoma (24.5%), pheochromocytoma (12.9%), and metastatic cancer (10.1%). In total, there were 19 various histopathological diagnoses in this group. Conclusion: Although adrenal cancer is the most likely diagnosis in large adrenal tumours, a broad spectrum of various adrenal and retroperitoneal tumours with size more than 5 cm can be found in such patients. (Endokrynol Pol 2017; 68 (4): 411-415)

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“…We have interpreted prior reports (2,3) as demonstrations that the stress of cancer enhances cortisol production and dexamethasone resistance in proportion to the extent of tumor burden. We suspect that cancer patients with bilateral adrenal metastases have greater stress-induced cortisol production than patients with unilateral adrenal metastases.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, the premortem diagnosis of adrenal insufficiency due to adrenal metastases is uncommon (1). Past studies have reported that the initial response to metastatic involvement of the adrenals is an increase in cortisol release, which is resistant to dexamethasone suppression (2,3). Thus, the typical cancer patient with metastases to adrenal glands has increased cortisol levels.…”

Section: Introductionmentioning

confidence: 99%

Adrenal Insufficiency With Normal Serum Cortisol Due to Large, Bilateral Adrenal Metastases

Maiorini

Chan

Shapiro

2018

AACE Clinical Case Reports

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Objective: Herein, we report a case of adrenal insufficiency due to bilateral adrenal metastases in which random serum cortisol was in the normal range.Methods: Case details and literature review. Results:A 68-year-old woman under treatment for ovarian cancer was referred for endocrine consultation because of bilateral adrenal metastases, weakness, and orthostatic symptoms. Biochemical evaluation found that despite normal levels of serum cortisol, she had primary adrenal insufficiency. A review of the literature found that normal levels of serum cortisol are typical in rare cases of adrenal insufficiency due to adrenal metastases. Conclusion:In cancer patients with bilateral adrenal metastases, cortisol production is enhanced and unregulated. In those rare cases when adrenal insufficiency is caused by bilateral adrenal metastases, serum cortisol may be normal, and accurate diagnosis requires further biochemical evaluation, including measurement of plasma adrenocorticotropic hormone (ACTH) and serum cortisol after infusion of synthetic ACTH. (AACE Clinical Case Rep. 2018;4:e282-e284) Abbreviation: ACTH = adrenocorticotropic hormone

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Adrenocortical function in patients with macrometastases of the adrenal gland

Cited by 42 publications

References 32 publications

Adrenal Crisis: Still a Deadly Event in the 21st Century

Adrenal Crisis: Still a Deadly Event in the 21st Century

Adrenal tumour bigger than 5 cm — what could it be? An analysis of 139 cases

Adrenal Insufficiency With Normal Serum Cortisol Due to Large, Bilateral Adrenal Metastases

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