Adrenal Insufficiency As the Presenting Feature in a Patient With Lung Cancer

Adrenal Insufficiency Associated with Small Cell Lung Cancer: A Case Report and Literature Review

“…Additionally, bilateral adrenal metastasis observed in the present patient has been reported to occur in less than 3% of all lung cancer patients. Most of the cases of adrenal metastasis are relatively small and asymptomatic [2] with no clinical significance [3,8].…”

“…Lam et al reported that only three of 421(0.7%) cases with metastasis adrenal tumors by carcinomas had clinical findings and endocrinological evidence of Addisonʼs disease by metastasis of lung adenocarcinoma [4]. In the reports of 22 cases which were able to evaluate clinical characteristics and outcome in the English and Japanese literature search which we performed since 1980 [8,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29], 19 cases had adrenal insufficiency associated with NSCLC (the pathological type of lung cancer was unknown in one case) and most of them were adenocarcinoma (Table 2). On the other hand, only two cases of adrenal insufficiency associated with SCLC have been previously reported; one was diagnosed by a low serum cortisol level (≦ 2.5 µg/dl) with an elevation of ACTH (241 pg/ml) [23], while the other was diagnosed by a low serum cortisol level (3.0 µg/ml) [16].…”

“…On the other hand, only two cases of adrenal insufficiency associated with SCLC have been previously reported; one was diagnosed by a low serum cortisol level (≦ 2.5 µg/dl) with an elevation of ACTH (241 pg/ml) [23], while the other was diagnosed by a low serum cortisol level (3.0 µg/ml) [16]. Generally, adrenal insufficiency is diagnosed according to a low serum cortisol level (< 3 µg/dl) in the early morning with a high basal plasma ACTH level [11] and a high-dose cosyntropin stimulation test [30]; the criteria of serum cortisol levels less than 4.4 µg/l before and 1 h after an administration of cosyntropin was reported to be clinically important for the diagnosis of adrenal insufficiency [8]. Corticosteroids are often used in patients with advanced lung cancer [19], and corticosteroid treatment is occasionally performed prior to an adequate endocrinological evaluation, similar to the present case at the first visit.…”

“…Adrenal insufficiency complicated with tuberculosis was previously frequently observed in Japan, but has decreased [7]; autoimmune adrenalitis has become common and is observed in 49-93% of all patients with adrenal insufficiency [8], while adrenal insufficiency complicated with all types of cancer have been only fewer than 100 cases in the previously literature [4]. Adrenal insufficiency associated with lung cancer, however, is extremely rare [9].…”

Just another abdominal pain? Psoas abscess-likemetastasis in large cell lung cancer with adrenal insufficiency

“…Symptoms are usually non-specific, such as weight loss, tiredness, abdominal pain, diarrhoea, nausea and vomiting, common in patients with cancer, which may mask adrenal insufficiency. Many patients present with hypotension, dehydration, postural hypotension and, in case of adrenal crisis, syncope and shock 25. Patients with advanced cancer are often under corticoids, which can also mask the symptoms of adrenal insufficiency.…”