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8 - Bilateral giant adrenal metastases accompanying to non-small cell lung carcinoma
Ahmet Mesrur Halefoğlu, Abdullah Soydan Mahmutoğlu, Nuran Yılmaz, Ayşe Deniz Kahraman, Zeki Karpat
The adrenal gland is one of the common sites of metastasis from primary lung cancer. Adrenal metastases are usually unilateral, however bilateral adrenal metastases are seen in 10% of all lung cancer patients; of these 2-3% occurs at the initial presentation of non-small cell lung cancer. Secondary tumors can disrupt the structure and function of the adrenal. This can lead to adrenal hemorrhage, which constitutes a life threatening hazard for the patient. A 54 year-old male presented with back pain and cough. His initial work-up revealed significant anemia, a speculated mass in the hiler region of the left lung and large masses of heterogeneous texture which presumably composed of hemorrhagic and necrotic elements in both adrenal glands. A biopsy confirmed the malign nature of the mass in the lung to be an adenocarcinoma of the lungs. The patient died suddenly one week after the administration of chemotherapy, due to adrenal failure. Intratumoral hemorrhage is a rare but life threatening complication of adrenal metastases and should be treated as soon as it has been diagnosed. If adrenalectomy is not feasible, combination chemotherapy should be applied as in metastatic disease. In order to choose the appropriate chemotherapeutic regimen it is important to accurately establish the diagnosis.
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