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━━ Background. Adrenal hemorrhage due to lung cancer metastasis is rare. We experienced a patient who exhibited short-term survival with massive adrenal hemorrhage secondary to lung cancer metastasis. Case. A 68-year-old man with a cough and fatigue was referred to our hospital. Computed tomography (CT) and 18F-fluorodeoxy glucose positron emission tomography (FDG-PET) showed a nodule in the right upper lobe, rightsided pleural effusion, multiple osteolytic bone metastases and metastasis to the bilateral adrenal glands. A cytological examination of the right-sided pleural effusion showed lung adenocarcinoma. Chemotherapy was planned; however, urgent hospitalization became necessary because of subcutaneous hemorrhage around the back of the patient’s abdomen on the right side at the level of the waist. He was found to have anemia on blood tests in addition to right adrenal hemorrhage secondary to lung cancer metastasis on CT. He was observed conservatively. Nevertheless, re-bleeding occurred on the 9th day, and embolization was performed. Because the lung cancer progressed rapidly, he chose supportive care and ultimately died 25 days after hospitalization. Conclusions. Adrenal hemorrhage due to lung cancer metastasis is rare. However, physicians must be aware that the prognosis for such cases is very poor. (JJLC. 2015;55:183-187) KEY WORDS━━ Lung cancer, Adrenal hemorrhage, Adrenal metastasis Received February 10, 2015; accepted May 24, 2015. 要旨━━背景.副腎は原発性肺癌の頻度の高い転移部 位であるが,肺癌副腎転移巣からの出血の報告は稀であ る.今回,副腎転移からの出血を契機に診断から短期間 で死亡した症例を経験したので報告する.症例.68 歳男 性.咳と倦怠感を主訴に当院を受診した.CTにて右上葉 結節影と右胸水,両副腎腫大の所見があり,右胸水細胞 診で腺癌細胞を認め,FDG-PET検査を含めた全身精査 の結果,IV期原発性肺腺癌と診断した.抗癌剤治療のた め入院予定であったが,初診から 12 日目に右腰部背側に 皮下出血が出現し救急外来を受診.血液検査でヘモグロ ビン値の低下があり,腹部CTで右副腎の著明な腫大と 周囲の液体貯留像を認め右副腎転移巣からの出血と診断 した.輸血を行い保存的に経過をみたが,入院第 9病日 に再出血を認めたため右副腎動脈造影と塞栓術を施行し た.その後は肺癌の進行による呼吸不全悪化のため緩和 治療の方針となり,入院から 25 日目に死亡した.結論. 肺癌の副腎転移巣からの出血は予後不良な経過をたどる ことが多く,臨床上注意が必要である. 索引用語━━肺癌,副腎出血,副腎転移 名古屋市立大学大学院医学研究科 1呼吸器・免疫アレルギー内 科学,2放射線医学分野. 受付日:2015 年 2 月 10 日,採択日:2015 年 5 月 24 日. (肺癌.2015;55:183-187) 2015 The Japan Lung Cancer Society Massive Hemorrhage from Adrenal Metastasis of Lung Cancer―Umeshita et al 184 Japanese Journal of Lung Cancer―Vol 55, No 3, Jun 20, 2015―www.haigan.gr.jp Table 1. Laboratory Data on the Initial Visit and Admission Initial visit Admission Initial visit Admission Hematology Biochemistry WBC 11,900 16,800 /mm3 TP 6.7 5.9 g/dl Neu 62.7 74.4 % Alb 3.8 2.9 g/dl RBC 429×104 242×104 /mm3 CK 36 21 IU/l Hb 13.6 7.5 g/dl AST 13 12 IU/l Plt 25.8×104 35.8×104 /mm3 ALT 9 7 IU/l Hemostatic test LDH 174 227 IU/l Fib 407 524 mg/dl BUN 14 14 mg/dl PT-INR 1.24 1.33 Cr 0.7 0.6 mg/dl APTT 28.7 30.5 sec Glu 95 119 mg/dl FDP n.d 90.7 μg/dl Na 139 125 mEq/l D-dimer 77.9 42.1 μg/dl K 4.6 4.3 mEq/l Serology Cl 101 89 mEq/l CRP 1.60 8.10 mg/dl Ca 9.5 8.8 mg/dl CEA 15.8 n.d ng/dl CYFRA 4.5 n.d ng/dl Pro-GRP 43.2 n.d pg/dl

Short-term Survival of Lung Adenocarcinoma with Massive Adrenal Hemorrhage Secondary to Lung Cancer Metastasis: a Case Report