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Management of undifferentiated adrenal gland metastases from malignant melanoma: case report
Hannah Shortreed1, Nishigandha Burute1,2, Olexiy Aseyev1,3,4
1Department of Undergraduate Medical Education, Northern Ontario School of Medicine University, Thunder Bay, ON, Canada.
Abstract:
Adrenal gland metastases from malignant melanoma are a common but poorly characterised condition. Their lack of consistent clinical features and poor response to immune checkpoint inhibitors pose a significant diagnostic and therapeutic challenge to practitioners. This case report describes a 78-year-old male with no prior history of melanoma presenting with nonspecific abdominal symptoms and unintentional weight loss who was found to have undifferentiated bilateral adrenal gland metastases from malignant melanoma. Despite ongoing investigations, the primary site of the adrenal gland metastases remained unknown, prompting the consideration of primary adrenal melanoma as a diagnosis. The patient underwent four cycles of treatment with immune checkpoint inhibitors, nivolumab and ipilimumab, followed by maintenance therapy and subsequent adrenal metastasectomy. Despite therapeutic efforts, the patient's tumour was resistant to treatment and became undifferentiated. The patient continued with palliative care until his death, more than three years after the onset of symptoms. The clinical features, pathophysiology, diagnosis, treatment, and prognosis of this patient's disease are discussed in detail to help inform the management of similar cases.
Insights
Metastatic melanoma commonly affects the adrenal glands but presents challenges in diagnosis and treatment. This case highlights a rare instance of bilateral adrenal metastases with an unknown primary site, resistant to immunotherapy.
Area of Science:
- Oncology
- Endocrinology
Background:
- Adrenal gland metastases from malignant melanoma are common but poorly understood.
- Lack of distinct clinical features and resistance to immune checkpoint inhibitors (ICIs) complicate management.
Observation:
- A 78-year-old male presented with nonspecific symptoms and weight loss.
- Bilateral adrenal gland metastases from malignant melanoma were diagnosed, with the primary site remaining unidentified.
- Primary adrenal melanoma was considered due to the unknown primary.
Findings:
- The patient received nivolumab and ipilimumab, followed by maintenance therapy and adrenal metastasectomy.
- Tumor demonstrated resistance to treatment, becoming undifferentiated.
- Prognosis was poor, with palliative care initiated until death over three years post-symptom onset.
Implications:
- This case underscores the diagnostic and therapeutic challenges of adrenal metastases from melanoma.
- Further research into effective treatments for this resistant malignancy is warranted.
- Understanding the pathophysiology and optimizing management strategies are crucial for improving patient outcomes.
