Adrenal and bone metastases as the initial presentation of endometrial carcinoma are rare. We report a case of endometrial carcinoma in a 47-year-old woman with initial manifestation as right chest wall pain, which was suspected as adrenal cortical carcinoma with rib metastasis after diagnostic CT scan. However, uterine and pelvic bone lesions were revealed by staging FDG PET/CT. Eventually, endometrial carcinoma with adrenal and bone metastases was confirmed pathologically.