From the Research
Adrenal gland rupture with hemorrhage is an extremely rare complication in patients with metastatic endometrial cancer, with no established frequency due to its rarity, but considered an uncommon occurrence even among patients with adrenal metastases. When endometrial cancer metastasizes, it typically spreads to lymph nodes, lungs, liver, and bones before affecting the adrenal glands. Even when adrenal metastases do occur, they rarely cause gland rupture and hemorrhage. This complication is more commonly associated with certain other cancers like melanoma, lung cancer, and renal cell carcinoma.
Key Points
- The exact frequency of adrenal gland rupture with hemorrhage in patients with metastatic endometrial cancer is not well-established in medical literature due to its rarity.
- Adrenal metastases from endometrial cancer are extremely rare, with a poor prognosis, especially for bilateral adrenal metastases, as reported in a case study published in 2021 1.
- When adrenal hemorrhage does occur, it presents with sudden-onset flank or abdominal pain, hypotension, and sometimes fever.
- The pathophysiology involves tumor invasion causing vascular compromise, necrosis, and eventual rupture of the adrenal gland.
- Treatment typically requires immediate medical attention, often including surgical intervention to control bleeding and stabilize the patient, as suggested by a review of metastatic carcinomas of the adrenal glands published in 2019 2.
Clinical Considerations
- Clinicians managing patients with metastatic endometrial cancer should be aware of this rare but potentially life-threatening complication, particularly in patients presenting with acute abdominal or flank pain.
- A comprehensive review of treatments for metastatic endometrial cancer, including hormonal therapy, cytotoxic chemotherapy, and targeted therapies, is essential for optimal patient management, as discussed in a review published in 2009 3.
- Adrenalectomy following metastatic disease to the adrenals should be performed when the lesion is isolated in the gland and the site of primary cancer has or can be resected, as recommended by a systematic review published in 2019 2.