Presentation
Metastatic breast cancer.
Patient Data
Age: 75 years
Gender: Female
From the case:
Large bilateral adrenal masses - metastases
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Bilateral adrenal masses (~7.8 cm right and ~7.9 cm left). Necrotic areas within, especially on the right.
No solid organ metastases.
Extensive established thoracolumbar vertebral body fractures. Ill-defined sclerosis may relate to metastatic disease.
Case Discussion
The differential for bilateral adrenal masses includes metastases, lymphoma, tuberculosis, and endocrine malignancies.
The commonest cause of bilateral adrenal nodules larger than 4cm, as in this case, is metastases.
This scenario can be used in fellowship examinations to test knowledge base and practical experience; bilateral pheochromocytomas are not the most likely in the real world!
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