Primary adrenal insufficiency due to bilateral infiltrative disease

Justine Herndon, Ashley M. Nadeau, Caroline J. Davidge-Pitts, William Francis Young, Irina Bancos

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose: Evidence on clinical presentation, evaluation, and management of patients with primary adrenal insufficiency (PAI) due to bilateral adrenal infiltrative disease is scarce. Our objective was to review the clinical presentation, biochemical work-up, imaging findings, and management of patients with PAI due to infiltrative adrenal disease in order to determine the best diagnostic and management approach. Methods: Retrospective study of patients with PAI due to bilateral infiltrative adrenal disease referred for adrenal biopsy during 2000–2014 at Mayo Clinic, Rochester, Minnesota. Two additional patients evaluated after 2014 were included. Results: Seven patients (six males and one female) were diagnosed with PAI caused by bilateral adrenal infiltrative disease at a median age of 54 (range 36–80) years. Duration of symptoms prior to the diagnosis of PAI and initiating treatment was 6 months (range 3 months–4 years). All patients demonstrated bilateral adrenal masses on adrenal imaging. The underlying diagnosis was confirmed by histopathology and included: bilateral adrenal metastases (lung and breast adenocarcinoma), diffuse large B-cell lymphoma, tuberculosis, cryptococcus, histoplasmosis, and, Erdheim-Chester disease. Conclusion: In patients with newly diagnosed PAI, the differential diagnosis should include bilateral infiltrative adrenal disease, especially when testing for autoimmune adrenalitis is negative, or if there is clinical history suggesting another etiology. Patients who present with known bilateral adrenal infiltrative disease should be counseled and tested for PAI periodically, particularly if presenting with suggestive signs or symptoms.

Original languageEnglish (US)
JournalEndocrine
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Addison Disease
Erdheim-Chester Disease
Cryptococcus
Histoplasmosis
Lymphoma, Large B-Cell, Diffuse
Signs and Symptoms
Tuberculosis
Breast
Differential Diagnosis
Retrospective Studies
Neoplasm Metastasis
Biopsy

Keywords

  • Histiocytosis
  • Histoplasmosis
  • Lymphoma
  • Metastasis
  • Primary adrenal insufficiency

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Herndon, J., Nadeau, A. M., Davidge-Pitts, C. J., Young, W. F., & Bancos, I. (Accepted/In press). Primary adrenal insufficiency due to bilateral infiltrative disease. Endocrine. https://doi.org/10.1007/s12020-018-1737-7

Primary adrenal insufficiency due to bilateral infiltrative disease. / Herndon, Justine; Nadeau, Ashley M.; Davidge-Pitts, Caroline J.; Young, William Francis; Bancos, Irina.

In: Endocrine, 01.01.2018.

Research output: Contribution to journalArticle

Herndon, Justine ; Nadeau, Ashley M. ; Davidge-Pitts, Caroline J. ; Young, William Francis ; Bancos, Irina. / Primary adrenal insufficiency due to bilateral infiltrative disease. In: Endocrine. 2018.
@article{33a30fc3bd66441e9253e2de6f369123,
title = "Primary adrenal insufficiency due to bilateral infiltrative disease",
abstract = "Purpose: Evidence on clinical presentation, evaluation, and management of patients with primary adrenal insufficiency (PAI) due to bilateral adrenal infiltrative disease is scarce. Our objective was to review the clinical presentation, biochemical work-up, imaging findings, and management of patients with PAI due to infiltrative adrenal disease in order to determine the best diagnostic and management approach. Methods: Retrospective study of patients with PAI due to bilateral infiltrative adrenal disease referred for adrenal biopsy during 2000–2014 at Mayo Clinic, Rochester, Minnesota. Two additional patients evaluated after 2014 were included. Results: Seven patients (six males and one female) were diagnosed with PAI caused by bilateral adrenal infiltrative disease at a median age of 54 (range 36–80) years. Duration of symptoms prior to the diagnosis of PAI and initiating treatment was 6 months (range 3 months–4 years). All patients demonstrated bilateral adrenal masses on adrenal imaging. The underlying diagnosis was confirmed by histopathology and included: bilateral adrenal metastases (lung and breast adenocarcinoma), diffuse large B-cell lymphoma, tuberculosis, cryptococcus, histoplasmosis, and, Erdheim-Chester disease. Conclusion: In patients with newly diagnosed PAI, the differential diagnosis should include bilateral infiltrative adrenal disease, especially when testing for autoimmune adrenalitis is negative, or if there is clinical history suggesting another etiology. Patients who present with known bilateral adrenal infiltrative disease should be counseled and tested for PAI periodically, particularly if presenting with suggestive signs or symptoms.",
keywords = "Histiocytosis, Histoplasmosis, Lymphoma, Metastasis, Primary adrenal insufficiency",
author = "Justine Herndon and Nadeau, {Ashley M.} and Davidge-Pitts, {Caroline J.} and Young, {William Francis} and Irina Bancos",
year = "2018",
month = "1",
day = "1",
doi = "10.1007/s12020-018-1737-7",
language = "English (US)",
journal = "Endocrine",
issn = "1355-008X",
publisher = "Humana Press",

}

TY - JOUR

T1 - Primary adrenal insufficiency due to bilateral infiltrative disease

AU - Herndon, Justine

AU - Nadeau, Ashley M.

AU - Davidge-Pitts, Caroline J.

AU - Young, William Francis

AU - Bancos, Irina

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Purpose: Evidence on clinical presentation, evaluation, and management of patients with primary adrenal insufficiency (PAI) due to bilateral adrenal infiltrative disease is scarce. Our objective was to review the clinical presentation, biochemical work-up, imaging findings, and management of patients with PAI due to infiltrative adrenal disease in order to determine the best diagnostic and management approach. Methods: Retrospective study of patients with PAI due to bilateral infiltrative adrenal disease referred for adrenal biopsy during 2000–2014 at Mayo Clinic, Rochester, Minnesota. Two additional patients evaluated after 2014 were included. Results: Seven patients (six males and one female) were diagnosed with PAI caused by bilateral adrenal infiltrative disease at a median age of 54 (range 36–80) years. Duration of symptoms prior to the diagnosis of PAI and initiating treatment was 6 months (range 3 months–4 years). All patients demonstrated bilateral adrenal masses on adrenal imaging. The underlying diagnosis was confirmed by histopathology and included: bilateral adrenal metastases (lung and breast adenocarcinoma), diffuse large B-cell lymphoma, tuberculosis, cryptococcus, histoplasmosis, and, Erdheim-Chester disease. Conclusion: In patients with newly diagnosed PAI, the differential diagnosis should include bilateral infiltrative adrenal disease, especially when testing for autoimmune adrenalitis is negative, or if there is clinical history suggesting another etiology. Patients who present with known bilateral adrenal infiltrative disease should be counseled and tested for PAI periodically, particularly if presenting with suggestive signs or symptoms.

AB - Purpose: Evidence on clinical presentation, evaluation, and management of patients with primary adrenal insufficiency (PAI) due to bilateral adrenal infiltrative disease is scarce. Our objective was to review the clinical presentation, biochemical work-up, imaging findings, and management of patients with PAI due to infiltrative adrenal disease in order to determine the best diagnostic and management approach. Methods: Retrospective study of patients with PAI due to bilateral infiltrative adrenal disease referred for adrenal biopsy during 2000–2014 at Mayo Clinic, Rochester, Minnesota. Two additional patients evaluated after 2014 were included. Results: Seven patients (six males and one female) were diagnosed with PAI caused by bilateral adrenal infiltrative disease at a median age of 54 (range 36–80) years. Duration of symptoms prior to the diagnosis of PAI and initiating treatment was 6 months (range 3 months–4 years). All patients demonstrated bilateral adrenal masses on adrenal imaging. The underlying diagnosis was confirmed by histopathology and included: bilateral adrenal metastases (lung and breast adenocarcinoma), diffuse large B-cell lymphoma, tuberculosis, cryptococcus, histoplasmosis, and, Erdheim-Chester disease. Conclusion: In patients with newly diagnosed PAI, the differential diagnosis should include bilateral infiltrative adrenal disease, especially when testing for autoimmune adrenalitis is negative, or if there is clinical history suggesting another etiology. Patients who present with known bilateral adrenal infiltrative disease should be counseled and tested for PAI periodically, particularly if presenting with suggestive signs or symptoms.

KW - Histiocytosis

KW - Histoplasmosis

KW - Lymphoma

KW - Metastasis

KW - Primary adrenal insufficiency

UR - http://www.scopus.com/inward/record.url?scp=85052964593&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85052964593&partnerID=8YFLogxK

U2 - 10.1007/s12020-018-1737-7

DO - 10.1007/s12020-018-1737-7

M3 - Article

JO - Endocrine

JF - Endocrine

SN - 1355-008X

ER -