A 78-year-old Japanese man with
fatigue, appetite loss, skin
hyperpigmentation,
hypotension and
hypoglycemia, visited our hospital to evaluate an abnormal chest X-ray and adrenal gland swelling in echography in February 2015. Chest computed tomography showed a mass lesion in the right lower lobe and bilateral adrenal swellings, and
small cell lung cancer (SCLC) with bilateral adrenal
metastasis was diagnosed after bronchoscopy. According to low levels of serum
cortisol, elevated
adrenocorticotropic hormone (
ACTH) and rapid
ACTH test, the diagnosis of
adrenal insufficiency associated with SCLC was made. Treatment with
hydrocortisone (20 mg/day) was started in addition to systemic
chemotherapy with
carboplatin and
etoposide. The patient's symptoms were slightly improved, however, systemic
chemotherapy was discontinued according to the patient's request after 1 course of
chemotherapy. Thereafter, he received only supportive care, and his general condition gradually worsened and he ultimately died in August 2015.
Adrenal insufficiency associated with SCLC, which is caused by tissue destruction more than 90% of the adrenal glands, is rare although adrenal
metastasis is not rare in patients with
lung cancer. The findings such as general
fatigue, appetite loss,
hypotension, and
hyponatremia are often got follow up as findings of advanced
cancer, but appropriate
therapy for
adrenal insufficiency, supplement of the adrenal
corticosteroid hormone, may lead to a significant improvement in the symptoms and quality of life in clinical practice of
lung cancer. Therefore, physicians must consider potential
adrenal insufficiency in
lung cancer patients with bilateral adrenal
metastasis.