Symptomatic large bilateral adrenal metastases at presentation in small-cell lung cancer: a case report and review of the literature.

The adrenal gland is a common site for metastasis from lung cancer. Adrenal metastases are usually solitary, asymptomatic and diagnosed incidentally during staging of patients with lung cancer. Bilateral adrenal metastases at the time of diagnosis are seen in 3% of lung cancer patients. Large symptomatic bilateral adrenal metastases at presentation are extremely rare and those occurring in the setting of small cell lung cancer (SCLC) have not been reported previously. Herein we describe a 46-year old male patient with SCLC who was symptomatic from large bilateral adrenal metastases at presentation. The patient was successfully treated with conventional platinum based chemotherapy and had no complications related to the large adrenal masses (intratumoral hemorrhage or adrenal insufficiency) either at presentation or subsequently during treatment and follow up.