Page 23 - Delaware Medical Journal - October 2017
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CASE REPORT
FIGURE 1
Patient #1 side-by-side comparison to her biological sister.
FIGURE 2
Patient #1 hyperpigmentation of dorsal and palmar aspect of hands.
was started on Fulvestrant, a selective estrogen receptor degrader (SERD), and hydrocortisone 15 mg daily. Through April 2017 she clinically continues to do well and has gained weight.
Patient #2: A 59-year-old female
with a past medical history of tobacco removal, appendectomy, cholecystectomy, and diabetes, was diagnosed with left
breast IDC stage IIA (pT1c, pN1a, pM0) that was ER positive, PR positive in radical mastectomy and axillary
lymph node dissection. The patient received adjuvant Cyclophosphamide
+ Methotrexate + Fluorouracil. She remained without clinical evidence of cancer for 13 years. In 2005 she was admitted to the hospital with six months of profound fatigue, 98 pound weight loss,
diffuse hyperpigmentation, and acute hypotension. She was discovered to be in hypo adrenal crisis. CT scan of chest/ abdomen/pelvis revealed left adrenal mass 3.1 x 1.9 cm and right adrenal
mass 2.9 cm. (Figure 4) CT guided carcinoma consistent with breast origin that was strongly positive for ER. PET scan revealed increase uptake in bilateral adrenal glands. She was started on
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