Cushing syndrome cardiomyopathy: an unusual manifestation of small-cell lung cancer

Abstract

Cushing syndrome is a rare cause of dilated cardiomyopathy and heart failure with reduced ejection fraction. Cases describing this association are scarce. We describe a patient presenting with acute heart failure, new cardiomyopathy, refractory hypokalaemia, severe hyperglycaemia, and uncontrolled hypertension who was found to have hypercortisolism secondary to an ectopic adrenocorticotropic hormone-secreting primary lung neoplasm. This case highlights the effects of hypercortisolism on the myocardium. The finding of a non-dilated cardiomyopathy in this case is unique because the majority of previously reported Cushing syndrome cardiomyopathy cases have described left ventricular dilatation or significant left ventricular hypertrophy. In addition, small-cell lung cancer with adrenocorticotropic hormone production causing Cushing syndrome cardiomyopathy is rare.

Keywords: Acute heart failure; Cancer; Cardiomyopathy; Cushing syndrome; Reduced ejection fraction.

FIGURE 1

Echocardiogram images on presentation. (A) LV wall thickness and internal diameter in parasternal long axis view. Apical four‐chamber view in diastole (B) and systole (C). LV volumes and ejection fraction were obtained by modified Simpson method (biplane method of disks). IVSed, interventricular septum at end‐diastole; LVIDed, LV internal diameter at end‐diastole; LVPWed, LV posterior wall thickness at end‐diastole; LVEDV, LV end‐diastolic volume; LVESV, LV end‐systolic volume; LVEF, LV ejection fraction.

FIGURE 2

Hypercortisolism and heart failure with reduced ejection fraction leading to a diagnosis of metastatic small‐cell lung carcinoma. Computed tomography (CT) chest and abdomen illustrating: (A) enlarged mediastinal and hilar lymph nodes (yellow circle); (B) irregular nodule in the right upper lobe of the lung measuring 1.2 × 0.9 cm (yellow circle); (C) hepatomegaly with innumerable hypodense masses consistent with metastatic disease.