98-3-13-Case Presentation-Co-secretion-Ald-Cortisol-Adenoma

Endocrine Grand Rounds
Case 13-03-98: A 48-year-old woman with 8 yrs Hx. Of HTN, muscle cramps, weakness, and also missed hypokalemia and bilateral adrenal masses.

Dr. M. zahedi and,  Dr. R. vasheghani farahani

• CC: Severe Generalized weakness
• PI: The patient was A 48-year-old woman who was referred to Taleghani emergency department on 12/11/97 because of sever generalized weakness and inability to walk and move.

She had known case of HTN (for 8 years) and suffered from massive nausea, vomiting (twice daily–non bloody-1 hour after meal) and watery diarrhea(twice daily, bulky, non bloody) for one week before this statement.

Because of  the worsening  of  the weakness she had fallen down without unconsciousness and head trauma.

• Based on severe hypokalemia, CV line was inserted in ED, and kcl infusion was done (30cc in liter/3liter/day, with cardiac monitoring).
• At the first lab data:

     There were leukopenia and raised ESR which was treated with tazocin and meropenem as sepsis.

     there was pre renal azotemia that had been resolved after serum therapy.

• Due to leukopenia, hematological consultation was requested Who advised to continue antibiotics and follow up.

     Also there was raised liver enzymes with hepatocellular pattern.

• Patient was transferred to the ICU and stayed there for one week.

• Diarrhea exacerbated in ICU and by GI consultation, pentasa supp. Was prescribed. Also they advised abdominopelvic sonography, then CT scan and endo & colonoscopy.
• On sonography  just dilated intestinal loops were detected.
• Abdominal CT scan showed:

    two hypo dense lesions to size 12*16*3 mm in the anterior side of the left liver lobe and

     20*32 mm mass in the right adrenal and 30*20mm mass in the left adrenal gland.

• Endo and colonoscopy (without preparation) were normal.