Adrenal insufficiency caused by bilateral adrenal metastases - a rare treatable cause for recurrent nausea and vomiting in metastatic breast cancer

Background: Nausea and vomiting are common symptoms in patients
with malignant disease. Several, sometimes rare causes have to be
considered to decide the right treatment. Case Report: We report of
a patient suffering from advanced breast cancer and complaining of
severe nausea and vomiting over several weeks without any
successful treatment. Later on, she developed marked
hyperpigmentation of the skin and hypo-osmolar dehydration. Adrenal
enlargement was noted in an abdominal scan. The suspected diagnosis
of primary adrenocortical insufficiency due to metastases was
confirmed by laboratory tests. After replacement therapy with
hydrocortisone and fludrocortisone, the general condition of the
patient improved dramatically and the symptoms of nausea and
vomiting disappeared completely. Conclusion: If a patient with
advanced cancer presents with unexplained and protracted nausea,
vomiting and weakness, particularly if accompanied by hyponatremia
and normal potassium levels, adrenal insufficiency due to adrenal
metastases should be considered.