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Background <p>This case presents a rare occurrence of an elderly male patient diagnosed with concurrent esophageal squamous cell carcinoma (ESCC) and medullary thyroid carcinoma (MTC) accompanied by adrenal insufficiency. The complexity of managing multiple malignancies alongside endocrine disorders highlights the need for improved recognition and prompt intervention. This report contributes to the understanding of the interplay between malignancies and endocrine dysfunction, particularly in the context of immunotherapy, thereby emphasizing the significance of thorough clinical monitoring in similar cases.</p> Case presentation <p>A 70-year-old Chinese male was admitted on May 28, 2021, with dysphagia lasting one month. Investigations confirmed a large, inoperable upper thoracic ESCC (cT4bNxM0 IVA). He underwent a chemotherapy regimen combining albumin-bound paclitaxel, and cisplatin, along with camrelizumab immunotherapy, completing a total of six cycles over five hospitalizations. On January 12, 2022, he was readmitted for hematemesis, leading to the discovery of electrolyte imbalances and subsequent diagnosis of hypothyroidism, for which he began levothyroxine. Diagnosis of MTC was made on June 21, 2022, confirmed via ultrasound-guided fine needle aspiration. Surgical intervention on July 28 involved total thyroidectomy, revealing a malignant thyroid tumor with a Ki-67 index indicative of low-grade malignancy. However, he faced multiple hospital admissions for persistent nausea, vomiting, and electrolyte disturbances, ultimately leading to the diagnosis of central adrenal insufficiency on December 18, 2023. The patient’s electrolyte levels normalized with appropriate corticosteroid therapy and monitoring.</p> Conclusions <p>The coexistence of ESCC, MTC, and central adrenal insufficiency creates notable challenges for diagnosis and treatment. This case highlights two key points: first, the critical role of interdisciplinary collaboration in identifying and managing endocrine dysfunctions linked to malignancies; second, the need for heightened clinical vigilance when monitoring patients on immunotherapy, to detect potential endocrine complications early. These steps are essential to optimize patient outcomes and refine management protocols for complex oncology cases</p>

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A rare case of multiple malignant tumors combined with central adrenal insufficiency: a case report

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月29日

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  • Pinpin Kong,
  • Pengshuai Liu,
  • Xiaofeng Liu,
  • Yaobin Li,
  • Xiaopeng Tian,
  • Xiaofang Sun

摘要

Background

This case presents a rare occurrence of an elderly male patient diagnosed with concurrent esophageal squamous cell carcinoma (ESCC) and medullary thyroid carcinoma (MTC) accompanied by adrenal insufficiency. The complexity of managing multiple malignancies alongside endocrine disorders highlights the need for improved recognition and prompt intervention. This report contributes to the understanding of the interplay between malignancies and endocrine dysfunction, particularly in the context of immunotherapy, thereby emphasizing the significance of thorough clinical monitoring in similar cases.

Case presentation

A 70-year-old Chinese male was admitted on May 28, 2021, with dysphagia lasting one month. Investigations confirmed a large, inoperable upper thoracic ESCC (cT4bNxM0 IVA). He underwent a chemotherapy regimen combining albumin-bound paclitaxel, and cisplatin, along with camrelizumab immunotherapy, completing a total of six cycles over five hospitalizations. On January 12, 2022, he was readmitted for hematemesis, leading to the discovery of electrolyte imbalances and subsequent diagnosis of hypothyroidism, for which he began levothyroxine. Diagnosis of MTC was made on June 21, 2022, confirmed via ultrasound-guided fine needle aspiration. Surgical intervention on July 28 involved total thyroidectomy, revealing a malignant thyroid tumor with a Ki-67 index indicative of low-grade malignancy. However, he faced multiple hospital admissions for persistent nausea, vomiting, and electrolyte disturbances, ultimately leading to the diagnosis of central adrenal insufficiency on December 18, 2023. The patient’s electrolyte levels normalized with appropriate corticosteroid therapy and monitoring.

Conclusions

The coexistence of ESCC, MTC, and central adrenal insufficiency creates notable challenges for diagnosis and treatment. This case highlights two key points: first, the critical role of interdisciplinary collaboration in identifying and managing endocrine dysfunctions linked to malignancies; second, the need for heightened clinical vigilance when monitoring patients on immunotherapy, to detect potential endocrine complications early. These steps are essential to optimize patient outcomes and refine management protocols for complex oncology cases