Asymmetric intense bilateral adrenal uptake on [ 18F] fluorodeoxyglucose positron emission tomography/computed tomography in a patient with solitary pulmonary nodule
Journal
Journal of Clinical Oncology
Journal Volume
30
Journal Issue
6
Pages
e83-e85
Date Issued
2012
Author(s)
Abstract
A 70-year-old woman was admitted to our hospital because of progressive facial and bilateral leg swelling and weight gain for 2 months. The long-standing mild diabetes mellitus and hypertension of the patient became difficult to control recently. There was no history of drug use, fever, or other discomfort. On examination, she presented with Cushingoid features (ie, moon face, acne, eyelid swelling, prominent pitting edema of bilateral legs, and skin atrophy) and high blood pressure up to 197/91 mmHg. Laboratory results showed severe hypokalemia (serum potassium, 1.9 mmol/L [reference range, 3.5 to 5.3 mmol/L]), increased fasting glucose (176 mg/dL), lower thyroid-stimulating hormone (0.007 U/mL [reference range, 0.1 to 4.5 U/mL]), increased serum cortisol with loss of diurnal secretion (am: 40.5 g/dL; pm: 47.4 g/dL [reference range, am: 5 to 24 g/dL; pm: 2.5 to 12.5 g/dL]), and increased adrenocorticotropic hormone (ACTH) level (am: 266 pg/mL; pm: 143 pg/mL [reference range, 10 to 65 pg/mL]). The follicle-stimulating hormone and luteinizing hormone levels were within the normal range but close to the lower limits. Plasma ACTH and cortisol were not suppressible by either low or high doses of dexamethasone. These presenting clinical pictures and endocrine data suggested a clinical diagnosis of ectopic ACTH syndrome. A pituitary magnetic resonance imaging scan was normal. The patient was treated with potassium supplement, vasodilator, and insulin therapy. A right middle lobe (RML) lung tumor of 1.67 cm and thickening of bilateral adrenal glands were found in the
Other Subjects
corticotropin; fluorodeoxyglucose f 18; hydrocortisone; insulin; potassium; vasodilator agent; adrenal hyperplasia; aged; article; case report; clinical assessment; clinical feature; computer assisted emission tomography; diabetes mellitus; diagnostic imaging; differential diagnosis; female; hormone blood level; human; hypertension; image analysis; immunohistochemistry; immunoreactivity; laboratory diagnosis; lung nodule; nuclear magnetic resonance imaging; positron emission tomography; priority journal; Adrenal Glands; Aged; Bronchial Neoplasms; Carcinoid Tumor; Female; Fluorodeoxyglucose F18; Humans; Hyperplasia; Positron-Emission Tomography and Computed Tomography; Radiopharmaceuticals; Solitary Pulmonary Nodule; Tomography, X-Ray Computed
Type
journal article