Bilateral adrenal masses with adrenal insufficiency: an unusual presentation of hepatocellular carcinoma

Adrenal insufficiency due to adrenal metastasis is rare and may be present only in 6.1% cases even in bilateral adrenal metastasis. The adrenal glands can maintain its cortisol axis until over 90% of adrenal cortex is destroyed. Bilateral large adrenal masses with adrenal insufficiency, though rare, should prompt further evaluation for a metastatic disease. We report a case of bilateral adrenal masses secondary to metastatic hepatocellular carcinoma causing adrenal insufficiency.