Acute secondary adrenal insufficiency as the presenting manifestation of small-cell lung carcinoma

Kinjal K. Shah, Robert J. Anderson

Research output: Contribution to journalArticle

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.

Original languageEnglish
Article number2032241
JournalBMJ Case Reports
DOIs
StatePublished - Feb 14 2014
Externally publishedYes

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Adrenal Insufficiency
Small Cell Lung Carcinoma
Pituitary Gland
Neoplasm Metastasis
Azotemia
Diplopia
Hypogonadism
Hemoptysis
Syncope
Hypothyroidism
Neuroimaging
Hypotension
Headache
Kidney
Brain

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

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AB - 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.

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