title: Metastatic adrenocortical carcinoma presenting simultaneously with Cushing's and Conn's syndromes: a case report.
abstract: We report the first case of adrenocortical carcinoma secreting cortisol (Cushing's syndrome) and aldosterone (Conn's syndrome) with extensive distant metastasis at the time of diagnosis. A 72-year-old male with exertional dyspnea sought evaluation at our institution. The pattern of tumor spread (lung, pleura, bone and adrenal gland) and respiratory symptoms secondary to the tumor led clinicians to diagnose the primary tumor site as lung cancer and the adrenal mass as a metastatic site. However, endocrinologic studies and a biopsy revealed the primary site to be adrenocortical carcinoma. After histopathologic confirmation, the patient was treated with palliative chemotherapy, including mitotane, cisplatin, etoposide and doxorubicin. The patient died on the 14th day after chemotherapy of rapidly progressive and unexpected pneumonia, which was thought to be an opportunistic infection secondary to Cushing's syndrome. Our case suggests that a thorough endocrinologic investigation is important in patients with an adrenal mass and clinicians should be aware that patients with adrenocortical carcinoma and Cushing's syndrome are susceptible to infections and need to be observed carefully for the possible development of unrecognized opportunistic infections.
authors: Department of Internal Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeongi-do 463-707, Republic of Korea.
authors: Seung Hoon
authors: SH
authors: Beom
authors: Keun-Wook
authors: KW
authors: Lee
authors: Yaewon
authors: Y
authors: Yang
authors: Younak
authors: Y
authors: Choi
authors: Kyoung-Ho
authors: KH
authors: Song
authors: Yu Jung
authors: YJ
authors: Kim
authors: Jee Hyun
authors: JH
authors: Kim
authors: Soo-Mee
authors: SM
authors: Bang
authors: Jin-Haeng
authors: JH
authors: Chung
authors: Jong Seok
authors: JS
authors: Lee
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D018268:Adrenocortical Carcinoma / Q000150:complications* / Q000188:drug therapy / Q000556:secondary; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D003480:Cushing Syndrome / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D017809:Fatal Outcome; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D008175:Lung Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000556:secondary; D008297:Male; D008939:Mitotane / Q000008:administration & dosage; D011014:Pneumonia / Q000209:etiology*; D014057:Tomography, X-Ray Computed
chemical_list: D005047:Etoposide; D008939:Mitotane; D004317:Doxorubicin; D002945:Cisplatin