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. 2018 Mar 8:2018:18-0004.
doi: 10.1530/EDM-18-0004. eCollection 2018.

Case-series of paraneoplastic Cushing syndrome in small-cell lung cancer

Carine Ghassan Richa  1   2 , Khadija Jamal Saad  1   2 , Georges Habib Halabi  1   3 , Elie Mekhael Gharios  1   3 , Fadi Louis Nasr  3 , Marie Tanios Merheb  1   3
Affiliations

Case-series of paraneoplastic Cushing syndrome in small-cell lung cancer

Carine Ghassan Richa et al. Endocrinol Diabetes Metab Case Rep. .

Abstract

The objective of this study is to report three cases of paraneoplastic or ectopic Cushing syndrome, which is a rare phenomenon of the adrenocorticotropic hormone (ACTH)-dependent Cushing syndrome. Three cases are reported in respect of clinical presentation, diagnosis and treatment in addition to relevant literature review. The results showed that ectopic ACTH secretion can be associated with different types of neoplasm most common of which are bronchial carcinoid tumors, which are slow-growing, well-differentiated neoplasms with a favorable prognosis and small-cell lung cancer, which are poorly differentiated tumors with a poor outcome. The latter is present in two out of three cases and in the remaining one, primary tumor could not be localized, representing a small fraction of patients with paraneoplastic Cushing. Diagnosis is established in the setting of high clinical suspicion by documenting an elevated cortisol level, ACTH and doing dexamethasone suppression test. Treatment options include management of the primary tumor by surgery and chemotherapy and treating Cushing syndrome. Prognosis is poor in SCLC. We concluded that in front of a high clinical suspicion, ectopic Cushing syndrome diagnosis should be considered, and identification of the primary tumor is essential.

Learning points: Learning how to suspect ectopic Cushing syndrome and confirm it among all the causes of excess cortisol.Distinguish between occult and severe ectopic Cushing syndrome and etiology.Providing the adequate treatment of the primary tumor as well as for the cortisol excess.Prognosis depends on the differentiation and type of the primary malignancy.

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Figures

Figure 1
Figure 1
Right central lung mass with increased uptake measuring 46 mm in diameter and standardized uptake values of 12.58 on PET scan.
Figure 2
Figure 2
Liver metastasis on PET scan.
Figure 3
Figure 3
2 enlarged anterior mediastinal lymph nodes seen in PET scan.
Figure 4
Figure 4
Multiple mediastinal lymph nodes, the biggest one subcarinal measuring 3 × 3 cm (white arrow), left and right hilar adenopathies on CT of the chest.
Figure 5
Figure 5
Liver metastasis on CT of abdomen.
See this image and copyright information in PMC

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