Retroperitoneal hemorrage due to bilateral adrenal metastases from lung adenocarcinoma
Retroperitoneal hemorrage due to bilateral adrenal metastases from lung adenocarcinoma
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DOI：
10.1007/bf03344146
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发表时间：
2006-06-01
影响因子：
5.4
通讯作者：
Yoshino, G.
中科院分区：
文献类型：
--
作者：
Hiroi, N.;Yanagisawa, R.;Yoshino, G.
一名56岁男性患者在切除肺腺癌（IIIA期）一个月后因严重背部疼痛入院，未发现肾上腺肿块。腹部电脑断层扫描显示双侧肾上腺肿瘤出血。内分泌实验室研究显示高血浆ACTH和正常血清皮质醇水平与昼夜节律丧失。虽然血浆ACTH水平升高，但对人促肾上腺皮质激素（hCRH）的使用没有皮质醇反应。对右肾上腺肿瘤进行了芯针活检，发现腺癌细胞与先前检查的原发性肺肿瘤相似。我们诊断为腹膜后出血是由于双侧肾上腺转移的肺腺癌伴肾上腺功能不全。肾上腺转移最常起源于原发性肺肿瘤，其次是胃、食道和肝脏/胆管。大约一半的肾上腺转移患者出现双侧肾上腺转移。临床上明显的肾上腺转移性出血极为罕见，这些患者常出现腹部、胸部或背部疼痛、恶心呕吐、精神错乱、虚弱、低血压、休克和高热等非特异性症状。我们报告一例因肺腺癌转移引起的大量腹膜后出血及肾上腺功能不全。
A 56-yr-old man was admitted to our university hospital for severe back pain one month after a resection for lung adenocarcinoma (stage IIIA) without evidence of the adrenal mass. Computed tomography (CT) of the abdomen showed bilateral bleeding of adrenal tumors. Endocrinological laboratory studies showed high plasma ACTH and normal serum cortisol levels with the loss of circadian rhythm. Although plasma ACTH levels increased, there was no cortisol response to administration of human corticotropichormone (hCRH). Core-needle biopsy was performed on the right adrenal tumor and revealed adenocarcinoma cells mimicking a primary lung tumor previously examined. We diagnosed retroperitoneal hemorrhage due to bilateral adrenal gland metastasis from lung adenocarcinoma with adrenal insufficiency. Adrenal metastases most commonly originate from a primary lung tumor, followed by stomach, esophagus and liver/bile ducts. Bilateral adrenal metastases were noted in approximately half of all adrenal metastases patients. Clinically significant adrenal hemorrhage by metastasis is exceedingly rare and non-specific symptoms, such as abdominal, chest or back pain, nausea and vomiting, confusion, weakness, hypotension, shock and high fever, are often observed in these patients. We present a case of massive retroperitoneal hemorrhage and adrenal insufficiency due to adrenal gland metastasis from adenocarcinorna of lung.