A 63-year-old male patient with a history of active smoking (40 packs/year), chronic arterial hypertension and type 2 diabetes mellitus treated with oral hypoglycemic agents, coronary heart disease and chronic arterial disease of the lower limbs.
complained of multiple episodes of asthenia, adynamia, weight loss, hyperpigmentation of skin and mucous membranes, episodes of lipothymia and symptomatic hypoglycemia despite reduction of urgent hypoglycemic therapy
It was diagnosed with ACTH and confirmed with a hormonal study described in Table 1, highlighting the high value of plasmatic ACTH, absence of plasma cortisol response to ACTH stimulation and high levels of plasma cortisol activity.
Treatment was initiated with hydroisoone 30 mg/d and fludrois acetate 0.1 mg/d.
1.
One month after the beginning of the treatment, the patient presented diffuse abdominal pain, nausea, vomiting and vomiting, and was admitted to the emergency service under regular general conditions, hypotensive, tachycardic, with signs of normal abdominal irritation.
Among the admission tests, hyponatremia, hyperkalemia, absence of leukocytosis and acute renal failure stood out, interpreting the picture as addisonian crisis without being able to identify a triggering factor.
Hydatidiformis was managed with iv.v. correction of extracellular volume with good response.
Given the history of chronic smoking and the search for tuberculosis as the etiology of PSI, a chest X-ray showed opacity in the right upper pulmonary lobe, anergic PPD and negative HIV serology.
Computed tomography (CT) of the chest and abdomen revealed a solid expansive lesion in the right lung of 24 x 41 mm, with contours and spiculated, with thick bilateral areas of adenofields and left adrenal nodules (24 mm, calcified).
Fiberoptic bronchoscopy showed partial occlusion of the right upper segmental bronchus by mucosal tumor, with bacilloscopy (-).
Cytology and transbronchial biopsy showed foci of poorly differentiated adenocarcinoma.
1.
In the study of neoplasia, 18 F-FDG PET/CT was performed, which showed a hypermetabolic pulmonary nodule in the right upper lobe compatible with ipsilateral hymenopae and pulmonary nodules, bilateral adrenal uptake value > 10,
With these backgrounds the diagnosis of lung cancer T2N2M1, stage IV and ISP due to bilateral adrenal metastasis and treated addisonian crisis is made.
She was admitted to palliative care and died one year after diagnosis.
