"Rescue" bilateral adrenalectomy in paraneoplastic Cushing's syndrome with invasive Aspergillus fumigatus infection.
We report the case of a patient with life-threatening Aspergillosis during paraneoplastic Cushing's syndrome. Anticortisolic drug ketoconazole was unable to lower severe hypercortisolism and despite antifungal treatment available at this time (liposomal amphotericine B and terbinafine), Aspergillus fumigatus infection was uncontrolled and extensive. "Rescue" bilateral adrenalectomy was performed to control hypercortisolism, leading to rapid fungal infection cure. We emphasize surgical management of hypercortisolism to achieve rapid blunting of cortisol production in a such life-threatening situation.
Joubert
Michael
M
Department of Endocrinology, University Hospital of Caen, Caen Cedex, France. joubert-m@chu-caen.fr
Reznik
Yves
Y
Verdon
Renaud
R
D000315:Adrenalectomy; D000308:Adrenocortical Hyperfunction / Q000188:drug therapy / Q000601:surgery; D000328:Adult; D001228:Aspergillosis / Q000209:etiology* / Q000517:prevention & control; D001232:Aspergillus fumigatus / Q000302:isolation & purification; D003480:Cushing Syndrome / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D003937:Diagnosis, Differential; D006801:Humans; D008168:Lung / Q000382:microbiology / Q000473:pathology; D008297:Male; D009384:Paraneoplastic Endocrine Syndromes / Q000150:complications* / Q000175:diagnosis / Q000601:surgery