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Vol.62 No.3 contents | Japanese/English |
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- Case Report -
A Case of Primary Lung Adenocarcinoma due to Bilateral Adrenal Metastases with Addison's Disease as the Initial Symptom
Yuta Kodama1, Masao Hiroshima2, Yusuke Tsushima1, Nozomi Goto1, Atsushi Nakase1, Mari Tanaka1, Masayasu Inagaki1, Ryota Ito1, Takashi Kohnoh1, Toshihiko Yokoyama11Department of Respiratory Medicine, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Japan, 2Department of General Medicine, Shinshiro Municipal Hospital, Japan
Background. Most lung cancer patients with bilateral adrenal metastases are asymptomatic. However, bilateral adrenal metastases may infrequently result in Addison's disease. These cases mainly occur during lung cancer treatment and Addison's disease is rarely found as an initial symptom. Case. The patient was a man in his seventies who had experienced general fatigue for approximately five months. Because he complained of sweating and abnormal behavior (including a strange voice on waking up), he was emergently admitted to our hospital. At admission, he presented hypoglycemic symptoms and pigmentation of the whole-body skin was observed. Chest computed tomography revealed a nodule in the left upper lung lobe. Abdominal computed tomography showed bilateral adrenal tumors that contained a low-density area and which showed heterogeneous enhancement. Blood tests showed a marked increase in adrenocorticotropic hormone and carcinoembryonic antigen and a marked decrease in cortisol. Based on these findings, he was diagnosed with Addison's disease due to bilateral adrenal tumors, and steroid replacement therapy rapidly improved his condition. Laparoscopic biopsy of the right adrenal tumor allowed us to finally diagnose primary lung adenocarcinoma based on the findings of immunohistochemical staining. At present, combination therapy with nivolumab and ipilimumab is being performed and has been effective for reducing the tumors. Conclusion. Since Addison's disease is a fatal but treatable disease, we should keep in mind that it may occur as a complication in lung cancer patients with bilateral adrenal metastases.
key words: Lung adenocarcinoma, Bilateral adrenal metastases, Addison's disease
Received: December 11, 2021
Accepted: January 26, 2022
JJLC 62 (3): 216-220, 2022
