title: Adrenal failure due to bilateral adrenal metastasis of rectal cancer: A case report.
abstract: BACKGROUND
  It is rare for a patient to present with adrenal insufficiency secondary to bilateral adrenal metastases from a malignant colorectal tumor.
  
  
  METHODS
  An 82-year-old Japanese man presented to our hospital with high fever and malaise. He was receiving oral chemotherapy for the treatment of rectal cancer with multiple metastases. Computed tomography showed new bilateral adrenal gland metastases. A rapid adrenocorticotropic hormone (ACTH) test showed adrenal insufficiency. Treatment with hydrocortisone provided immediate symptom improvement.
  
  
  CONCLUSIONS
  Adrenal insufficiency secondary to bilateral adrenal metastases from rectal cancer is rare. A rapid ACTH test is useful to diagnose adrenal insufficiency.
  
  
  CONCLUSIONS
  The incidence of adrenal insufficiency may be underestimated in patients with multiple metastasis. Appropriate therapy with adrenal corticosteroid hormone supplementation may lead to a significant improvement in the patient's symptoms and quality of life.
authors.affiliation: Department of Surgery, Innoshima Ishikai Hospital, 1962, Nakanosho, Innoshima, Onomichi, 722-7221, Japan. Electronic address: ub044982kkr@yahoo.co.jp.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Imaoka
authors.affiliation: Department of Surgery, Innoshima Ishikai Hospital, 1962, Nakanosho, Innoshima, Onomichi, 722-7221, Japan. Electronic address: ishikai@beach.ocn.ne.jp.
authors.forename: Fumito
authors.initials: F
authors.lastname: Kuranishi
authors.affiliation: Department of Surgery, Innoshima Ishikai Hospital, 1962, Nakanosho, Innoshima, Onomichi, 722-7221, Japan. Electronic address: iishikai@beach.ocn.ne.jp.
authors.forename: Yoshiteru
authors.initials: Y
authors.lastname: Ogawa
authors.affiliation: Department of Surgery, Onomichi General Hospital, 1-10-23, Hirahar, Onomich, 722-8508, Japan. Electronic address: hokuda.2nd-s@go5.enjoy.ne.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Okuda
authors.affiliation: Department of Surgery, Onomichi General Hospital, 1-10-23, Hirahar, Onomich, 722-8508, Japan. Electronic address: hokuda.2nd-s@go5.enjoy.ne.jp.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Nakahara
keywords: Adrenal failure; Bilateral adrenal metastases; Rapid ACTH test; Rectal cancer