title: Acute secondary adrenal insufficiency as the presenting manifestation of small-cell lung carcinoma.
abstract: A 66-year-old man, chronic smoker, presented with episodes of syncope, hypotension and constitutional symptoms. Initial evaluation revealed pre-renal azotaemia and acute secondary adrenal insufficiency.MRI performed was interpreted as a pituitary macroadenoma with enlargement of the infundibulum (stalk). Further endocrinological tests performed suggested central hypothyroidism and hypogonadism. Subsequent development of haemoptysis, headache and diplopia warranted further investigations, which revealed stage IV small-cell lung carcinoma with adrenal metastases. Subsequent brain imaging showed lesions in the brain parenchyma, pituitary and stalk, characteristic of metastases. Thus, we present a very atypical case of pituitary metastases presenting with acute secondary adrenal insufficiency.
authors: Section of Endocrinology and Metabolism, VA Nebraska-Western Iowa Healthcare System, Omaha, Nebraska, USA.
authors: Kinjal K
authors: KK
authors: Shah
authors: Robert J
authors: RJ
authors: Anderson
mesh_terms: D000208:Acute Disease; D000310:Adrenal Gland Neoplasms / Q000556:secondary*; D000309:Adrenal Insufficiency / Q000209:etiology*; D000368:Aged; D001932:Brain Neoplasms / Q000556:secondary*; D017809:Fatal Outcome; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000556:secondary*; D055752:Small Cell Lung Carcinoma / Q000175:diagnosis / Q000556:secondary*