Metastasis or Mimic? Navigating the Workup of a Large Adrenal Incidentaloma in the Setting of Lung Cancer
https://doi.org/10.15605/jafes.041.S1
- Author:
Mohd Firdaus Mohamad Kamil
1
;
Masliza Hanuni Mohd Ali
1
;
Wan Mohd Hafez Wan Hamzah
1
Author Information
1. Endocrinology Unit, Medical Department, Hospital Sultanah Nur Zahirah
- Publication Type:Journal Article
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):27-28
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:The identification of a significant adrenal mass in a patient
without a biopsy-confirmed malignancy poses a diagnostic
challenge: Is it a metastatic lesion or an underlying
adrenal condition? Adrenal metastases are the second
most common site of spread for lung adenocarcinoma;
approximately 3–7% of adrenal masses represent benign
adenomas. Diagnosis is even harder if there are signs of
primary aldosteronism (PA).
Case:We present a case of a 62-year-old Chinese female with
a 10-year history of hypertension, managed on dual
antihypertensive therapy, who presented for evaluation
of suspected PA following the discovery of hypokalemia.
Biochemical screening revealed an elevated aldosteronerenin ratio (ARR, 65). The overnight dexamethasone
suppression test (20 nmol/L) and testosterone (0.79 nmol/L)
were both within normal limits. Saline Suppression Test
(SST) showed an indeterminate post-infusion aldosterone
level (202.8 pmol/L). Cross-sectional imaging via computed
tomography (CT) Adrenals identified a large, 6.4 × 5.4 × 6.2
cm heterogeneous left suprarenal mass with a low mean
attenuation (8.6 Hounsfield Unit [HU]). Concurrently, an
incidental left upper lobe pulmonary lesion was identified,
and PET-CT was performed; the SUVmax of the lung was
identical to that of the adrenal lesion. An ultrasoundguided biopsy of the pulmonary lesion confirmed
estimated glomerular filtration rate-mutation-positive lung
adenocarcinoma. The patient started on targeted therapy
with dacomitinib. Follow-up CT imaging at 9 months
demonstrated disease progression within the thorax, marked by the appearance of a new pulmonary nodule.
Notably, however, the adrenal mass remained stable in size
and morphology.
Conclusion:The absence of mixed androgen/glucocorticoid hypersecretion, combined with the radiographically static nature
of the mass, suggests a lower probability of adrenocortical
carcinoma. This case highlights that while size is a major
risk factor for adrenocortical carcinoma, it must be
interpreted in conjunction with hormonal activity, HU, and
growth patterns. Identifying these “mimics” helps avoid
over-staging lung cancer and ensures patients receive
targeted therapy instead of unnecessary adrenalectomies.
- Full text:2026072813563836793EP_A017.pdf
