Adrenal insufficiency due to metastatic lung carcinoma and shown by abdominal CT scan.

Our patient's symptoms of adrenal insufficiency were the first evidence of recurrence of the primary tumor. The diagnosis of hypoadrenalism was established by the standard ACTH stimulation test. The elevated ACTH level provided corroborating evidence that this was primary adrenal insufficiency rather than secondary to hypothalamic-pituitary dysfunction. The CT scan of the abdomen then revealed bilateral adrenal gland enlargement as well as a less dense area in the spleen, both suggestive of metastatic disease. The CT scan has proven to be of value in diagnosing tumor involvement of the adrenal glands. The patient's response to hormonal replacement was both rapid and gratifying, and he was able to leave the hospital to resume his usual activities. The possibility of adrenal insufficiency should be considered in any patient with a history of carcinoma who has malaise, weakness, and weight loss. Adrenal insufficiency is a treatable condition, and treatment of it provides symptomatic relief that may increase the quality of life. As patients with cancer survive longer, this complication may be observed more frequently.