title: Impaired consciousness caused by a metastatic adrenal tumor of pulmonary adenocarcinoma.
abstract: We report a case of pulmonary adenocarcinoma metastasizing to the adrenal glands, which caused adrenal insufficiency leading to impaired consciousness. A 62 year-old man was admitted with impaired consciousness. The patient started chemotherapy from 2004 for pulmonary adenocarcinoma. In August 2004, a metastatic adrenal tumor was detected and chemotherapy was continued thereafter. From July 2005, the patient started to have mild hyperkalemia, anorexia and general malaise, which progressed to disturbance of consciousness. At admission, physical examination showed generalized pigmentation in the skin and mucosa. Blood test revealed hypoglycemia, hyponatremia and hyperkalemia. A dexamethasone suppression test and a rapid ACTH loading test led to a diagnosis of primary hypoadrenalism (Addison's disease). Treatment with hydrocortisone improved the physical status and blood test values. However, the patient subsequently died of disseminated intravascular coagulation due to the tumor.
authors.affiliation: Department of Internal Medicine, School of Medicine, Toho University, Sakura, Japan.
authors.forename: Kyouko
authors.initials: K
authors.lastname: Yokosuka
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Kawashima
authors.forename: Noriaki
authors.initials: N
authors.lastname: Okada
authors.forename: Tooru
authors.initials: T
authors.lastname: Wakabayashi
authors.forename: Sayaka
authors.initials: S
authors.lastname: Kawashima
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Kuroda
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Nishi
authors.forename: Masaaki
authors.initials: M
authors.lastname: Tanabe
authors.forename: Tsukane
authors.initials: T
authors.lastname: Gotoh
authors.forename: Kohji
authors.initials: K
authors.lastname: Shirai
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Matsuzawa
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000556:secondary; D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000556:secondary; D000309:Adrenal Insufficiency / Q000150:complications / Q000209:etiology; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D014474:Unconsciousness / Q000209:etiology*