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Large adrenal mass heralding the diagnosis of occult extra-adrenal malignancy in two patients
  1. James Anderton1,
  2. Marios Ghobrial2,
  3. Vasilis Kosmoliaptsis1 and
  4. Ruth Casey2
  1. 1Department of Surgery, University of Cambridge, Cambridge, UK
  2. 2Department of Endocrinology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  1. Correspondence to James Anderton; jra54{at}


We report two cases highlighting the role of fluorine-18-fluorodeoxyglucose positron emission tomography/computerised tomography (18F FDG PET/CT) in the diagnostic and preoperative workup of indeterminate adrenal masses. Case 1: a 60-year-old man was diagnosed with a large left-sided adrenal mass with indeterminate radiological characteristics on CT. Biochemical investigations ruled out tumour hypersecretion. 18F FDG PET/CT was performed to exclude metastases and identified a pulmonary nodule in the left upper lobe. Histology of the resected adrenal tumour demonstrated a secondary metastasis from an adenocarcinoma of the lung. Case 2: an 88-year-old male was found to have a heterogeneous and vascular left-sided suprarenal mass and a smaller right-sided adrenal nodule. Both adrenal nodules had indeterminate radiological characteristics. Biochemical investigations were negative. PET/CT demonstrated high avidity in the bilateral adrenal nodules but no extra-adrenal FDG avid disease. Histology demonstrated a metastatic carcinoma of pulmonary origin.

  • lung cancer (oncology)
  • radiology
  • adrenal disorders

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  • Contributors JA, MG, VK and RC wrote the report; VK and RC were involved in the clinical management of both patients.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.