title: Recurrent pulmonary embolism in an elderly patient with Cushing's syndrome, adrenocortical adenoma, pheochromocytoma and prostate adenocarcinoma.
abstract: Pulmonary embolism (PE) is a major health problem. Mortality in untreated PE is high, but with adequate (anticoagulant) treatment, can be reduced. Multiple primary and secondary risk factors are responsible for PE. But there is rare association of mixed adrenal tumor with PE. Here, we report a case of adrenocortical adenoma with Cushing's syndrome coexistent with pheochromocytoma with recurrent PE in an elderly patient with prostate adenocarcinoma. A 78-year-old Taiwanese retired veteran was admitted in July, 2002 with the presentation of syncope. Three years before, he was diagnosed with prostate adenocarcinoma and had received Androcur therapy since then. Five months later, he was admitted with Cushingoid appearance and hypertension. Abdominal imaging studies revealed a left adrenal tumor. Laparoscopic adrenalectomy revealed an adrenocortical adenoma. Two years later, a recurrent left adrenal tumor was found. Repeated laparoscopic adrenalectomy revealed pheochromocytoma. One month after the repeat laparoscopic surgery, the patient was admitted due to syncope. Chest X-ray revealed cardiomegaly with pulmonary venous congestion. Echocardiogram showed impaired right ventricle global systolic function. Perfusion lung scan showed a high probability of PE. Heparin and coumadin were given but stopped 5 weeks later due to the development of severe skin ecchymosis. In December 2002, the patient was admitted again with consciousness disturbance. Chest computed tomography (CT) revealed bilateral PE, and he died 5 hours later due to cardiogenic shock. In conclusion, in elderly patients with Cushing's syndrome with pheochromocytoma and prostate carcinoma, there is probability of pulmonary embolism.
authors.affiliation: Department of Medicine; Chi-Mei Medical Center Tainan Hsiang, Taiwan, ROC. fu9109@ms42.hinet.net
authors.forename: Chwen-Yi
authors.initials: CY
authors.lastname: Yang
authors.forename: Chien-Wen
authors.initials: CW
authors.lastname: Chou
authors.forename: Ming-Bin
authors.initials: MB
authors.lastname: Lin
authors.forename: Ching-Nan
authors.initials: CN
authors.lastname: Lin
authors.forename: Long-Whou
authors.initials: LW
authors.lastname: Wang
authors.forename: Su-Yu
authors.initials: SY
authors.lastname: Chen
authors.forename: Hon-Mei
authors.initials: HM
authors.lastname: Cheng
mesh_terms: D000230:Adenocarcinoma / Q000150:complications*; D000306:Adrenal Cortex Neoplasms / Q000150:complications; D000310:Adrenal Gland Neoplasms / Q000150:complications; D018246:Adrenocortical Adenoma / Q000150:complications*; D000368:Aged; D003480:Cushing Syndrome / Q000209:etiology*; D017809:Fatal Outcome; D006801:Humans; D008168:Lung / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D010673:Pheochromocytoma / Q000150:complications*; D011471:Prostatic Neoplasms / Q000150:complications*; D011655:Pulmonary Embolism / Q000209:etiology*; D012008:Recurrence; D013575:Syncope / Q000175:diagnosis / Q000209:etiology; D014057:Tomography, X-Ray Computed