We report the case of a 67-year-old woman who came to the emergency department with bilateral conjunctival edema of 3 weeks, after having been treated with artificial flavorings and topical ointment improvement during this period of time.
His personal history included hypertension under pharmacological treatment, diabetes mellitus difficult to control and newly diagnosed oral candidiasis.
The exploration revealed bilateral conjunctival chemosis with intense tear, the rest of which were normal.
The patient reported having lost 5 kg in the last 2 weeks, a feeling of generalised swelling mainly on the face, together with asthenia and generalized pruritus.
1.
After a systemic examination she was diagnosed with suspected Cu syndrome.
Hormonal analyses revealed an ACTH of 3 pg/mL (normal 10-55), basal plasma cortisol of 35.3 mcg/dL and urinary free cortisol (CLU) of 632 mcg/24h (normal < 180).
Chest X-ray and computed tomography (CT) were normal.
Abdominal CT showed a left adrenal mass of 8.2×5.4cm, suggestive of adrenal carcinoma, without locoregional lymphadenopathy.
1.
Given the clinical evolution, it was decided to start treatment with ketoconazole 400mg/day prior to surgery with the aim of inhibiting the secretion of adrenal cortisol, performing excision of the adrenal fat tumor together with dissection.
1.
The histology of the adrenal tumor was reported as «adrenal carcinoma with extensive area of proliferative activity, capsule that surrounds it with pericrine lymphatic vessels necrosis».
After a first course of chemotherapy with cisplatin-etoposisid, she was diagnosed 3 months later with local chemotherapy improvement due to progressive respiratory failure. The patient developed bilateral adrenal insufficiency, and she received weekly metastases in both hemithorax and adcriteria.
