胸腔内温熱化学療法後にCushing症候群を呈した異所性副腎皮質刺激ホルモン産生肺カルチノイド

Ectopic Adrenocorticotropic Hormone-Producing Pulmonary Carcinoid Presenting as Cushing’s Syndrome after Intrapleural Hyperthermic Chemotherapy

肺癌には種々の腫瘍随伴性内分泌症候群を合併することがあり，異所性副腎皮質刺激ホルモン（ACTH）産生腫瘍によるCushing症候群は異所性ACTH症候群と呼ばれ，肺癌全体の0.4〜2.0％に合併する1）．われわれは，右肺中葉肺癌疑い，臨床病期ⅠA2期の診断で胸腔鏡下右中葉切除術の予定であったが，術中に胸膜播種が発見されたため胸腔内温熱化学療法を施行し，術後に全身浮腫，低カリウム血症，高血糖を呈し，異所性ACTH症候群と診断した1例を経験したので報告する．

The patient was a woman in her 70’s was referred to our hospital because of an abnormal shadow on chest roentgenogram at an annual medical checkup. Since preoperative examinations suggested lung cancer in the right middle lobe, thoracoscopic right middle lobectomy was planned. However, pleural dissemination was detected at surgery and we changed the treatment plan to the intrapleural hyperthermic chemotherapy. During the postoperative course, facial edema, hypokalemia, and hyperglycemia developed, and the diagnosis of Cushing’s syndrome was suggested based on an increase in serum level of adrenocorticotropic hormone （ACTH） and cortisol, and was confirmed by a dexamethasone suppression test. Intrapleural hyperthermic chemotherapy was likely to collapse the ACTH-producing tumor leading Cushing’s syndrome.