We had a similar thought process to the comments posted.
We first tried a CT-guided Bx of the adrenal but it was not accessible. I did a bronch to get tissue (if it was a small-cell for instance than the adrenal would not change care that much). It confirmed a NSCLCa with features favoring an adenocarcinoma.
We did a PET scan as well (see below) and both the upper lobe lesion and the adrenal were "hot" the mean SUV for the adrenal was ~4.4.
So now we are back to the initial question: confirmed NSCLCa, moderate COPD with a hot-but-not-biopsied adrenal.
What would you recommend next?
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adrenalectomy and lung resection surgery, and hope for the best. One concern here is whether there is marrow involvment if it turns out that there is bone invasion by the tumor.....I would consult with an endocrinologist prior to the adrenalectomy, and do the work up needed for functional/non-functional adrenal tumor, as this does not have to be a metastatic neoplasm from the pulmonary source (especially that this tumor may have "bypassed" the lymph nodes and went to the adrenal...although on surgery mediastinal lymph nodes may be positive)...
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