الملخص الإنجليزي
A 30-year-old male patient presented to the emergency room of a community hospital in California, USA, in 2018 with lower abdominal pain. Abdominal computed tomography (CT) revealed a 9-cm mass in the left adrenal gland. Subsequently, the patient became very anxious and stressed and developed chest and abdominal pain, which resulted in more than 10 emergency room visits over the next few months. The pain reportedly subsided once the patient was prescribed benzodiazepine. He was then referred to the Ronald Reagan University of California Los Angeles Medical Center, Los Angeles, California, for management of the mass. At referral, the patient was currently taking esomeprazole and lorazepam. His past medical history included mild hypertension, obesity and kidney stones. Multiple family members had a history of malignancy. A physical examination indicated tachycardia and multiple acne lesions on the back. Biochemical tests revealed normal levels of catecholamines, metadrenalines, aldosterone, renin, potassium, dehydroepiandrosterone sulfate and cortisol. Various emotional states such as stress, anger, anxiety and fear increase blood flow to the facial skin. In the present case, the patient was under extreme stress due to the recent diagnosis of a potentially malignant abdominal mass and was very anxious during the FDG-PET procedure. However, upon physical examination, his facial skin appeared completely\ normal. It is therefore likely that the diffuse facial skin FDG uptake was due to emotional stress. While it is unknown if emotional stress can cause hyperaemia in the chest and abdominal skin, FDG uptake in these areas was normal. This case illustrates that multifocal skin FDG uptake can be due to benign lesions in patients with suspected malignancies and that diffuse facial skin FDG uptake may be due to emotional stress.
