Table 1.
All published cases of bilateral adrenal metastasis and adrenal insufficiency.
| First author | Age Sex | Cancer/Histology | Low BP | Post. low BP | Low Na | High K | Cortisol nmol/L (ug/dL) | ACTH pmol/L (pg/mL) | Peak cortisol after ACTH | Diagnosis | Largest size on CT (cm) left/right | Treatment and follow-up |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overt adrenal insufficiency | ||||||||||||
| Crisci et al[14] | 69M | Colorectal | N | Y | - | - | 220nmol (8ug/dL) | 63 pmol/L (290 pg/mL) | - | ACTH stimulation test | - | TX with GC and MC. SX improved. Alive 12 months. |
| Cosentino et al[15],∗ | 43M | Lung ac | Y | Y | Y | Y | 19 nmol/L (0.7ug/dL) | <2.2 pmol/L (<10 pg/mL) | - | Cortisol and ACTH | 12L 12R |
TX with GC and MC. Mortality - n/a |
| Imaoka et al[16] | 82M | Colorectal | N | - | N | Y | 215nmol (7.8ug/dL) | 6.6 pmol/L (28 pg/mL) | 499 nmol/L (18.1ug/dL) | ACTH stimulation test | 2.5L 1.9R |
TX with GC. Died 5 months later (unrelated to AI). |
| Mor et al[17] | 43M | Colorectal | Y | - | Y | Y | 408 nmol/L (14.8ug/dL) | 114 pmol/L (520 pg/mL) | 386 nmol/L (14.0ug/dL) | ACTH stimulation test | 7L 9R |
TX with GC. Died 8 months later. |
| Gul et al[36] | 47F | Gastric ac | N | Y | Y | Y | 275nmol (10ug/dL) | 30.8 pmol/L (140 pg/dL) | - | ACTH-stimulation test | 4.7L 3.8R |
TX with GC. Mortality - n/a |
| Faulhaber et al[19] | 69M | Lung signet ring cell ac | Y | - | Y | Y | 28nmol (1.03ug/dL) | 137.7 pmol/L (626 pg/mL) | - | Cortisol and ACTH | 5L 5R |
TX with GC and MC. SX resolved. Alive at 1 month |
| Noguchi et al[20] | 78M | Small cell lung | Y | - | Y | Y | 115 nmol/L (4.2ug/dL) | 55.8 pmol/L (254 pg/mL) | 77.2 nmol/L (2.8ug/dL) | ACTH-stimulation test | - | TX with GC. Died 4 months. |
| Bausewein et al[21] | 75F | Breast | Y | - | Y | Y | 148nmol (5.4ug/dL) | 329 pmol/L (1499 pg/mL) | 157.2 nmol/L (5.7ug/dL) | ACTH-stimulation test | - | TX with GC and MC. SX resolved. Mortality - n/a |
| Srinivasan et al[22] | 71M | Melanoma | Y | - | Y | - | - | - | - | ACTH-stimulation test | 9.6L 7.4R |
TX with GC. SX resolved. Died 6 months later. |
| Goffman et al[23] | 48M | Renal ca | Y | Y | Y | Y | 504 nmol/L (18.3ug/dL) | - | 675 nmol/L (24.5 ng/L) | ACTH-stimulation test | - | TX with GC. Died 3 days later. |
| Schnitzer et al[24] | 74M | Lymphoma | - | Y | Y | - | 22 nmol/L (0.8ug/dL) | - | - | ACTH-stimulation test | 4L 4R |
TX with GC. Died within 7 days. |
| Van den Heiligenberg et al[25] | 78M | Non-hodgkin lymphoma | N | - | - | - | - | - | - | ACTH-stimulation test | 5L 5R |
TX with GC. SX improved. Died 3 weeks later. |
| Yeo et al[26] | 78F | Breast | Y | - | - | - | 265 nmol/L (9.6ug/dL) | - | 235 nmol/L (8.5ug/dL) | ACTH-stimulation test | - | TX with GC. SX improved. Died 1 year later |
| Sheeler et al[27] Patient 1 |
52M | Lung ac | Y | Y | Y | Y | - | - | 248 nmol/L (9ug/dL) | ACTH -stimulation test 40IU BD for 48 hrs | - | TX with GC. Died 6 months later. |
| Sheeler et al[27] Patient 2 |
75F | Breast | Y | N | Y | Y | 182 nmol/L (6.6ug/dL) | 80.3 pmol/L (365 pg/mL) | 231 nmol/L (8.4ug/dL) | ACTH- stimulation test | - | TX with GC and MC. SX improved. Alive at 2 years. |
| Sheeler et al[27] Patient 3 |
65M | Small cell lung | Y | - | Y | Y | 510 nmol/L (18.5ug/dL) | - | 400 nmol/L (14.5ug/dL) | 48hr ACTH infusion | 8L 8R |
TX with GC. Mortality - n/a |
| Sheeler et al [27] Patient 4 |
70M | Large cell lung | N | - | Y | Y | 292 nmol/L (10.6ug/dL) | - | 513 nmol/L (18.6ug/dL) | ACTH-stimulation test | 3.5L 9R |
TX with GC. SX improved. Mortality - n/a |
| Seidenwurm et al[29] Patient 1 | 51M | Lung | - | - | - | - | 331 nmol/L (12ug/dL) | 55 pmol/L (252 pg/mL) | 358 nmol/L (13ug/dL) | ACTH-stimulation test | - | Responded to GC. Mortality - n/a |
| Seidenwurm et al[29] Patient 3 | 56M | Undifferentiated | - | - | - | - | 259 nmol/L (9.4ug/dL) | - | 303 nmol/L (11ug/dL) | ACTH-stimulation test | - | Responded to GC. Mortality - n/a |
| Seidenwurm et al[29] Patient 4 | 62M | Colon | - | - | - | - | - | - | - | ACTH-stimulation test | - | Responded to GC and MC. Mortality - n/a |
| Redman et al[30] Patient 1 |
- | - | - | - | - | - | 303 nmol/L (11ug/dL) | - | 331 nmol/L (12ug/dL) | ACTH-stimulation test | 5L 5R |
- |
| Redman et al[30] Patient 2 |
- | - | - | - | - | - | 745 nmol/L (27ug/dL) | - | 800 nmol/L (29ug/dL) | ACTH-stimulation test | 2.5L 2.5R |
- |
| Redman et al[30] Patient 3 |
- | - | - | - | - | - | 469 nmol/L (17ug/dL) | - | 524 nmol/L (19ug/dL) | ACTH-stimulation test | 4L 3R |
- |
| Redman et al[30] Patient 4 |
- | - | - | - | - | - | 993 nmol/L (36ug/dL) | - | 1020 nmol/L (37ug/dL) | ACTH-stimulation test | - | - |
| Redman et al[30] Patient 5 |
- | - | - | - | - | - | 386 nmol/L (14ug/dL) | - | 441 nmol/L (16ug/dL) | ACTH-stimulation test | 3.5L 1.5R |
- |
Units Cortisol nmol/L (mg/dL); Units ACTH pmol/L (pg/mL); BP = blood pressure; Post. low BP = postural low blood pressure, i.e., orthostatic hypotensiont; Low Na = hyponatremia; High K = hyperkalemia; Y = yes; N = no; ' - ' = not available; GC = glucocorticoids; ac = adenocarcinoma; MC = mineralocorticoids; SX = symptoms; TX = treatment; n/a = not available.
∗
Cosentino et al. [15] - features of primary and secondary AI.