[Hyponatremia caused by pituitary metastasis of lung cancer].

A 57-year-old man was admitted with headache, vomiting, and bloody sputum. We diagnosed large cell lung cancer T4N2M1 (pituitary metastasis), Stage IV. When hospitalized, low values of cortisol and hyponatremia were found. A hormone stimulation test was performed, because we suspected hypopituitarism. The reaction of adrenocorticotropic hormone (ACTH) to the corticotropin-releasing hormone (CRH) loading test was good, but the reaction of serum cortisol was minimal. After corticosteroid administration, his serum sodium normalized. Limited ACTH reserve according to insufficient pituitary function was suggested as a cause of the hyponatremia. He received gamma-knife therapy, however his pituitary gland tumor did not decrease in size. Clinical symptoms such as visual field disturbance, oculomotor paresis, and visual impairment progressed, and he died about 5 months later. We report a case of hyponatremia in a patient with pituitary metastasis of lung cancer, as it is comparatively rare.

[Pneumatosis cystoides intestinalis in a patient with lung cancer].

We report a case of pneumatosis cystoides intestinalis (PCI) in a patient with lung cancer. A 60-year-old woman was admitted with multiple lung tumors and multiple brain tumors. She was given steroid hormones to reduce her brain edema. Total resection of a brain tumor yielded a pathological diagnosis of metastatic squamous cell carcinoma. During treatment, X-ray and CT images revealed intestinal pneumatosis and free air in the abdominal cavity, but a physical examination revealed no abnormal findings. She was given a diagnosis of PCI, and received conservative treatment. Her intestinal gas cysts and intra-abdominal free air disappeared spontaneously. PCI is an uncommon but important condition in which gas is found in a linear or cystic form in the submucosa or subserosa of the bowel wall. It is important to consider PCI as a possible complication in lung cancer patients who are given steroid hormones and systemic chemotherapy in the long-term.

Invasive Tracheobronchial Aspergillosis with Bronchial Ulcers Complicated by Nontuberculous Mycobacterial Disease.

Invasive tracheobronchial aspergillosis (ITBA) complicated by nontuberculous mycobacteria (NTM) is rare. An 88-year-old man was admitted for hemoptysis. Bronchoscopy revealed bronchial ulcers, and a tissue biopsy showed Aspergillus fumigatus. He was diagnosed with ITBA, which improved with voriconazole. During treatment, infiltrative shadows appeared in his lungs, and bronchoscopy was performed once again. A non-necrotic epithelioid granuloma and Mycobacterium intracellulare were detected in the biopsy specimen. He was diagnosed with NTM disease. It is important to note that tracheobronchial ulcers may cause hemoptysis and to identify the etiology and treat it appropriately when multiple bacteria are found.