We report the case of a 47-year-old female patient who was admitted for a clinical picture started in June 2009 and characterized by asthenia, adynamia and difficulty in walking edema secondary to dyspnea and dyspnea.
Subsequently, she presented progressive edema that extended to the face and was associated with new pharmacological hypertension and local hospital and an increase of 32 kg of weight, approximately, in the last six months, without changes in diet, for which she was diagnosed with diabetes.
In October 2009, the patient presented hirsutism in the poles, meningeal, upper third of the thorax, alopecia and a fall in the outer third of the eyebrows.
She was assessed by the Endocrinology Department, where she considered the Cu syndrome and requested laboratory tests.
She persisted with progressive edema and inability to walk secondary to this, so she went to a local hospital where she was diagnosed with urinary tract infection by Enterococcus spp. and Escherichia coli persistent antibiotic therapy was started.
In addition, he had ecchymotic and petechial lesions in the extremities, with normal coagulation times and platelet count. Laboratory tests were performed which reported: thyrotropin (TSH), 1.12 IU/ml liver volume per patient 12
Upon admission to our institution, a patient weighing 117 kg was found with a body mass index (BMI) of 37.7 kg/m2, tachybasic acid with 2-oxygen according to nasal cannula.
She had musoid faces and signs of virilization, generalized edema predominantly in the lower limbs, and ecchymotic lesions at venipuncture sites, the anterior face of the right mammary glands, the hypoosus
He presented delirious ideas of persecution (“A woman made me witchcraft”) and strength 2/5 on upper limbs and 1/5 on lower limbs.
Due to the clinical picture and the findings in the physical examination, it was considered that the patient had an adrenal insufficiency syndrome (urinary adrenal insufficiency and adrenal cortisol concentration) 58.9 μg/dl, with a serum cortisol level of 58.9 μg/dl
Antihypertensive treatment, subcutaneous insulin and full anticoagulation were continued, as the patient presented chest pain associated with dyspnea. An acute coronary syndrome was ruled out, and a pulmonary thromboembolism was requested and continuous monitoring was requested.
On January 19, 2010, during her transfer to an abdominal CT, the patient had a cardiorespiratory arrest that did not respond to resuscitation maneuvers and died.
Since this was a patient without etiologic diagnosis, clinical autopsy was requested.
The Pathology Service reported a carcinoma of the left adrenal gland, weighing 400 g, with metastasis to the liver and extension to the vena cava; the latter triggered a massive thrombosis under the pressure of the vein, which was subsequently expelled.
