The clinical significance of metastases to the adrenal glands.

Seven patients, four of whom subsequently proved to have bilateral and three, unilateral adrenal metastases, were evaluated regarding adrenal activity. Three of the patients had clinical signs and symptoms similar to those usually associated with manifest adrenal insufficiency. Massive tumor growth, with less than 20 per cent residual amounts of apparently normal adrenal tissue, was found in three of the four patients with bilateral metastases. The metastases in the fourth patient were smaller and could only be detected microscopically. Evaluation of the adrenal activity included the determination of cortisol levels in plasma at 8 am, 2 pm and 8 pm; single dose dexamethasone suppression test with adrenocorticotropic hormone stimulation, and analysis of 24 hour urinary excretion of epinephrine and norepinephrine. In all seven patients, the plasma cortisol levels, dexamethasone suppression--adrenocorticotropic hormone stimulation test results and urinary excretion of epinephrine and norepinephrine were similar to those found in comparable patients without adrenal metastases. Thus, the metastases did not seem to be of any clinically significant importance for the patients. It was concluded that, apparently, only minimal amounts of residual adrenal tissue are sufficient to maintain, for basic conditions, normal production of cortisol and of epinephrine and to even respond to stress.