Year: 2026
Type: article
Study design: Case Report
Abstract: A 68-year-old man with newly diagnosed rectosigmoid tumor was referred for bilateral adrenal incidentalomas on staging computed tomography (CT). CT adrenals showed a 1.3 × 1.3 cm left adrenal nodule (unenhanced CT attenuation 27 Hounsfield units [HU]) and 4.2 × 4.6 cm right adrenal mass (unenhanced CT attenuation 34 HU [D], absolute washout 31%, relative washout 11% [E and F]) concerning for adrenal metastasis. Plasma pheochromocytoma screen was negative: normetanephrine 57.7 pg/mL (SI: 293 pmol/L) (reference range ≤ 233 pg/mL [SI: ≤1180 pmol/L]), metanephrine less than 39.5 pg/mL (SI: <200 pmol/L) (reference range ≤ 100 pg/mL [SI: ≤510 pmol/L]). Adrenal insufficiency from adrenal metastases was excluded with morning cortisol 13.3 μg/dL (SI: 368 nmol/L) (reference range, 6.0-18.0 μg/dL [SI: 166-507 nmol/L]). Fluorodeoxyglucose (FDG)-positron emission tomography (PET)-CT showed FDG-avid lesions in bilateral adrenals (G and H) and the primary sigmoid lesion (I). Right adrenal biopsy confirmed metastatic colorectal adenocarcinoma (J and K, original magnification ×50). Curative bilateral adrenalectomy is planned after anterior resection and chemotherapy for colorectal cancer. Adrenal metastases typically suggest widespread disease; isolated cases are rare. While bilateral adrenalectomy necessitates lifelong glucocorticoid/mineralocorticoid replacement, case reports [1] show good prognostic outcomes for isolated adrenal metastasis. This case highlights evaluation of bilateral adrenal masses in newly diagnosed extra-adrenal malignancy and management with curative adrenalectomy. All authors were involved in writing and reviewing the final manuscript. L.W., H.T.K., and N.J. were involved in the care of the patient. M.J.C. was involved in review of the radiology images and selection of appropriate images for the report. No public or commercial funding. None declared. Signed informed consent obtained directly from the patient. This case report does not involve genomic, sequencing, or other data requiring deposition in a public repository. All data supporting the findings of this report are presented within the manuscript; no additional datasets were generated or analyzed.
Source: JCEM Case Reports
Institution: Khoo Teck Puat Hospital
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $930
OpenAlex ID: W7223084561