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Case Reports
. 2023 Apr 11;17(1):132.
doi: 10.1186/s13256-023-03858-5.

Adrenal insufficiency after curative-intent gastric cancer treatment: a case report

Johan Hardvik Åkerström  1   2 , Cecilia Radkiewicz  3   4
Affiliations
Case Reports

Adrenal insufficiency after curative-intent gastric cancer treatment: a case report

Johan Hardvik Åkerström et al. J Med Case Rep. .

Abstract

Background: Adrenal insufficiency is a life-threatening condition, and advanced gastric cancer is associated with very poor prognosis. Adrenalectomy and/or metastatic invasion of the adrenal glands can cause primary adrenal insufficiency, which in turn can present with symptoms mimicking advanced cancer.

Case presentation: Herein we report of a 68-year-old White male with a history of left adrenalectomy in conjunction with distal gastrectomy due to gastric adenocarcinoma. At the 2-year follow-up visit after cancer surgery, the patient presented with fatigue, unintentional weight loss, hyperkalemia, and a computed tomography scan with a right adrenal mass. Primary adrenal insufficiency caused by gastric cancer metastatic invasion of the remaining right adrenal gland was established and glucocorticoid therapy initiated. The patient received first line palliative chemotherapy with systemic disease control and subsequent stereotactic body radiotherapy to the right adrenal gland. More than 17 months after pathology-confirmed gastric cancer relapse, there is no clinical nor radiological evidence of active malignant disease and the patient is doing well on glucocorticoid replacement therapy.

Conclusions: This case does not only illustrate the importance of prompt and correct clinical management of adrenal insufficiency, but also that selected patients with advanced gastric cancer can gain from and achieve long-term survival using a multimodal treatment approach.

Keywords: Adrenal insufficiency; Case report; Chemotherapy; Radiosurgery; Stomach neoplasms.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Routine 2-year control computed tomography (CT) of the upper abdomen. Consistent with a 3 cm × 6 cm right adrenal mass (arrow)
Fig. 2
Fig. 2
Therapy evaluation computed tomography (CT) of upper abdomen. With no radiological signs of extra-adrenal malignant disease and radiological response (shrinkage) of the right adrenal mass (arrow) after 3 months of first line palliative chemotherapy, followed by stereotactic body radiation therapy (SBRT) of the right adrenal gland
See this image and copyright information in PMC

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