Addison's Disease and Diabetes Insipidus

Abstract

The metastatic involvement of both adrenal glands with complete replacement by neoplasm, resulting in Addison's disease, is recognized as a most unusual if not rare occurrence.'16 The first well-documented cases in the American literature were reported by Butterly and his associates,l in 1952; Wallach and Scharfman,2 in 1952, and Sahagian-Edwards and Holland,3 in 1954 Masters 5 also reported a case of Addison's disease produced by metastasis from gastric carcinoma.Metastatic carcinoma to the pituitary gland involving both the anterior and posterior lobes and the hypothalamus, resulting in diabetes insipidus, is exceedingly rare."-8The survival of a patient 10 years after pneumonectomy for primary bronchogenic carcinoma, although not infrequently reported, remains an unusual occurrence.'0-'4 In personal communications Watson 1 stated he had four cases of 10-year survival, and in one of them a second primary lung cancer developed which was nonresectable. Overholt 13 reported a five-year cure rate of 19% and a 10-year cure rate of 16% following pneumonectomy. In other statistical studies the five-year survival rates are presented as ranging from 20% to 38%,15-18 but no figures are presented as indicative of 10-year survival rates.It is considered of interest to add another fully documented case of adrenal insufficiency secondary to metastatic bronchogenic carcinoma to those already reported. none of the previously reported cases did this syndrome occur in a case of bronchogenic carcinoma that survived 10 years after pulmonary resection. Diabetes insipidus with Addison's disease secondary to metastatic bronchogenic carcinoma has never been reported.The frequency of adrenal involvement in bronchogenic carcinoma has been reported by many observers to range from 30% to 45%.2,3,6,19 In the report of Sahagian-Edwards and Holland,3 there was a total of 354 cases of secondary carcinoma of the adrenal gland in 9582 autopsies. The commonest origin was the bronchus in 42%, and the female breast was next in frequency, with 34%. Bilateral adrenal metastasis occurred in 144 of the 354 cases, and, of these, 78 instances were in patients with bronchogenic carcinoma. Of the 144 cases with bilateral adrenal metastasis, 4 patients revealed recognizable adrenal insufficiency during life. In each instance the primary was bronchogenic carcinoma. Graham 19 very aptly stated that there is not even a theoretical explanation for the finding of metastasis to one or both adrenal glands at autopsy in cases of bronchogenic carcinoma.To find cerebral metastasis in bronchogenic carcinoma is not unusual. Knights 7 found primary bronchogenic carcinoma in males and primary breast carcinoma in females to be the commonest to metastasize to the brain. Of 109 cases of pulmonary carcinoma in his report, the brain was examined in 27 cases. Cerebral metastasis was noted in 14% of the 27 cases, but no reference was made to involvement of the pituitary or the hypothalamus. Willis 6