Reactions to Total Dose Intravenous Infusion of Iron Dextran (Imferon)

Abstract

The occurrence of the electrolyte changes may merely be a reflection of the severity of the disease and its duration.It is probable that our case was diagnosed very early in relation to the onset of the adrenal overactivity, and had the patient lived long enough it is likely that she might have developed the electrolyte changes.Her death was due to tracheal compression by the neoplasm and not to adrenal overactivity as is usual in these cases.The early or mild case may well escape detection, and in our case the diagnosis was made only by doing the right investigation for the wrong reason.It may well be that what we believe to be the typical case of this disease is in fact the late severe case, the milder earlier cases being missed. SummaryA case of Cushing's syndrome associated with a carcinoma of the bronchus is described.The unusual features were the complete absence of physical signs of Cushing's syndrome and the presence of normal plasma electrolytes.It is suggested that this may have been a very early example of this disease, which may be missed because of lack of clinical or biochemical abnor- malities that would direct attention to more detailed investiga- tion of the adrenal gland.Alternatively, the hyperplastic adrenal may be producing an 1 1-hydroxycorticosteroid other than cortisol, determined by our method for plasma cortisol and excreted in the urine as the usual breakdown products.We are grateful to Dr. C. H. C. Toussaint for allowing us to publish this report, and to Dr. R. A. B. Drury and Dr. U. F. Rowlatt for performing the post-mortem examination.Dr. P. M