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Adrenal metastases causing insufficiency — SCE Endocrinology MCQ

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ModerateAdrenalAdrenal metastases causing insufficiencySCE Endocrinology

A 60-year-old man with metastatic lung cancer has bilateral adrenal metastases. He is fatigued and hypotensive. Sodium is 129 mmol/L, potassium 5.6 mmol/L and 09:00 cortisol is 62 nmol/L. What is the most appropriate management?

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Correct answer: B — Treat suspected primary adrenal insufficiency with hydrocortisone

Bilateral adrenal metastases can cause primary adrenal insufficiency with hyperkalaemia and hypotension. Hydrocortisone should be given promptly if clinically unwell. SIADH is common in lung cancer but does not explain hyperkalaemia and very low cortisol.

Reference: NICE NG243; Society for Endocrinology Adrenal Crisis Guidance