title: An acute adrenal insufficiency revealing pituitary metastases of lung cancer in an elderly patient.
abstract: Metastases of solid tumors to the pituitary gland are often asymptomatic or appereas as with diabetes insipid us. Pituitary metastases more commonly affect the posterior lobe and the infundibulum than the anterior lobe. The presentation with an acute adrenal insufficiency is a rare event. A 69-year-old men presented with vomiting, low blood pressure and hypoglycemia. Hormonal exploration confirmed a hypopituitarism. Appropriate therapy was initiated urgently. The hypothalamic-pituitary MRI showed a pituitary hypertrophy, a nodular thickening of the pituitary stalk. The chest X Rays revealed pulmonary opacity. Computed tomography scan of the chest showed a multiples tumors with mediastinal lymphadenopathy. Bronchoscopy and biopsy demonstrated a pulmonary adenocarcinoma. Hence we concluded to a lung cancer with multiple pituitary and adrenal gland metastases. This case emphasizes the need for an etiological investigation of acute adrenal insufficiency after treatment of acute phase.
authors.affiliation: Department of Endocrinology and Internal Medecine, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
authors.forename: Hela
authors.initials: H
authors.lastname: Marmouch
authors.affiliation: Department of Endocrinology and Internal Medecine, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
authors.forename: Sondes
authors.initials: S
authors.lastname: Arfa
authors.affiliation: Department of Pneumology, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
authors.forename: Saoussen Cheikh
authors.initials: SC
authors.lastname: Mohamed
authors.affiliation: Department of Endocrinology and Internal Medecine, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
authors.forename: Tensim
authors.initials: T
authors.lastname: Slim
authors.affiliation: Department of Endocrinology and Internal Medecine, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
authors.forename: Ines
authors.initials: I
authors.lastname: Khochtali
mesh_terms: D000208:Acute Disease; D000230:Adenocarcinoma / Q000473:pathology*; D000077192:Adenocarcinoma of Lung; D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D000309:Adrenal Insufficiency / Q000209:etiology*; D000368:Aged; D001706:Biopsy; D001999:Bronchoscopy; D006801:Humans; D007018:Hypopituitarism / Q000209:etiology; D008175:Lung Neoplasms / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D014057:Tomography, X-Ray Computed
keywords: Pituitary metastasis; acute adrenal insufficiency; hypopituitarism; lung cancer