Incidence, diagnosis and treatment of adrenal metastases from differentiated thyroid carcinoma: personal experience and review of literature

Aim of the present work is to evaluate incidence, diagnosis and treatment of adrenal metastasis (AM) from a differentiated thyroid carcinoma (DTC) through a comparison of a case report with the review of literature. Our experience is based upon a case of isolated adrenal metastasis discovered during the follow up of a 71-year-old woman previously submitted to total thyroidectomy for a papillary carcinoma. In spite of repeated cycles of radioiodine therapy, 10 years after surgery she was discovered with high values of thyroglobulin (TG) associated with a left adrenal mass that showed high uptake at FDG PET/CT scan. Laparoscopic adrenalectomy (LA) was successfully performed and after 24 months, serum TG levels and 131 I whole body scan are normal and the patient free of disease. Incidence of AM from DTC is a very rare occurrence: its discovery usually comes through the follow up of patients submitted to total thyroidectomy The most useful tools to diagnose such metastases are serum levels of TG, 131I uptake and FDG PET/CT scan. Therapy depends if the AM is isolated or with synchronous recurrences in other organs. In the first case LA is the best option, while radioiodine should be the treatment of choice in the cases not fit for surgery Return to normal values of TG and lack of 131I uptake are the best way to confirm recovery from disease. AM from a DTC is nearly exceptional but should be suspected in case of increasing values of TG and high 131I uptake during post-thyroidectomy follow up; CT and PET scan are frequently necessary to confirm diagnosis. Surgical therapy is usually possible through LA.