Adrenal metastasis from papillary thyroid cancer: staged surgical resection

Adrenal gland metastasis from papillary thyroid carcinoma (PTC) is a rare and diagnostically challenging event. Approximately 15 cases of adrenal involvement have been published to date. We report a man in his 70s with previously treated PTC (pT2N1bMx) who re-presented with right cervical lymph node recurrence and a right adrenal mass measuring 5.7×6.5 cm detected on staging cross-sectional imaging. A CT-guided biopsy confirmed metastatic PTC. We performed staged surgery - right cervical lymph node dissection followed by open right adrenalectomy 4 weeks later. Serum thyroglobulin fell from >500 ng/mL preoperatively to <1 ng/mL at 6 months, with no evidence of disease on CT of the neck, chest and abdomen. This case illustrates the possibility of synchronous locoregional and adrenal recurrence in PTC and highlights that cross-sectional imaging of the abdomen is indicated when thyroglobulin is markedly elevated, as recommended by current guidelines.