title: Suspected metastatic adrenocortical carcinoma revealing as pulmonary Kaposi sarcoma in adrenal Cushing's syndrome.
abstract: BACKGROUND
  Kaposi sarcoma (KS) is a malignant disease most commonly diagnosed in the setting of a human immunodeficiency virus (HIV) infection and in patients receiving immunosuppressive treatment. Pulmonary KS has never been reported in association with endogenous Cushing's syndrome (CS).
  
  
  METHODS
  A 60-year-old woman presented with symptoms and signs of CS. Adrenal CS was confirmed by standard biochemical evaluation. Imaging revealed a right adrenal lesion (diameter 3.5 cm) and multiple pulmonary nodules, suggesting a cortisol-secreting adrenal carcinoma with pulmonary metastases. The patient underwent right adrenalectomy with a pathohistological diagnosis of an adrenal adenoma. Subsequent thoracoscopic wedge resection of one lung lesion revealed pulmonary KS with positive immunostaining for human herpes virus 8 (HHV-8). HIV-serology was negative. Hydrocortisone replacement was initiated for secondary adrenal insufficiency after surgery. Post-operative follow up imaging showed complete remission of all KS-related pulmonary nodules solely after resolution of hypercortisolism.
  
  
  CONCLUSIONS
  KS may occur in the setting of endogenous CS and may go into remission after cure of hypercortisolism without further specific treatment.
authors: Department of Medicine I, Endocrine and Diabetes Unit, University Hospital of Wuerzburg, Oberduerrbacherstrasse 6, Wuerzburg D-97080, Germany. bala_m@ukw.de.
authors: Margarita
authors: M
authors: Bala
authors: Cristina L
authors: CL
authors: Ronchi
authors: Josef
authors: J
authors: Pichl
authors: Vanessa
authors: V
authors: Wild
authors: Stefan
authors: S
authors: Kircher
authors: Bruno
authors: B
authors: Allolio
authors: Stefanie
authors: S
authors: Hahner
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery; D000315:Adrenalectomy; D018268:Adrenocortical Carcinoma / Q000150:complications / Q000473:pathology* / Q000601:surgery; D003480:Cushing Syndrome / Q000150:complications / Q000473:pathology* / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage; D008175:Lung Neoplasms / Q000150:complications / Q000556:secondary* / Q000601:surgery; D008875:Middle Aged; D011379:Prognosis; D012514:Sarcoma, Kaposi / Q000209:etiology / Q000473:pathology* / Q000601:surgery
chemical_list: D006854:Hydrocortisone