A case of massive adrenal hemorrhage secondary to metastasis of lung cancer

Abstract

Adrenal metastasis in lung cancer is often diagnosed, however, massive adrenal hemorrhage secondary to metastasis of lung cancer is extremely rare. We report here a case of massive adrenal hemorrhage secondary to metastasis of lung cancer. A 58-year-old man visited our emergency room complaining of sudden onset of severe left flank and back pain. Seven months before his admission, his lung cancer was diagnosed and chemotherapy with anti-cancer agents was given. Abdominal ultrasonography and computed tomography showed a solitary left adrenal tumor with massive hemorrhage (90 × 46mm). Laboratory findings showed anemia, however, acute adrenal failure could not be detected. Adrenal hemorrhage was carefully observed without surgery, because it was not progressive and a poor prognosis was predictable. The patient died from shock due to repeated massive hemorrhage about 2 months later. The signs and symptoms of massive adrenal hemorrhage are not specific, therefore, we should consider hemorrhagic adrenal metastasis in the differential diagnosis. Ultrasonography, CT, and MRI are quite useful in evaluation. Lung cancer patients with hemorrhagic adrenal metastasis have a dismal prognosis, and regaire careful consideration of the treatment for those with widely disseminated metastases.