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Case Reports
. 2023 Jul 2;2(3):77572.
doi: 10.56305/001c.77572. eCollection 2023.

Ectopic Cushing's Syndrome as the First Presenting Sign of Small Cell Lung Carcinoma

Manasa Srivillibhuthur  1 , Tammy Yu  1 , Martin Li  2 , Ingrid Mader  2 , Pinar Arikan  3
Affiliations
Case Reports

Ectopic Cushing's Syndrome as the First Presenting Sign of Small Cell Lung Carcinoma

Manasa Srivillibhuthur et al. J Brown Hosp Med. .

Abstract

A 67-year-old man with a history of hypertension, hyperlipidemia, coronary artery disease, and former smoking presented with fatigue, lower extremity edema, and a new tremor over the course of one month. Workup was notable for hypokalemia, metabolic alkalosis, and extremely elevated adrenocorticotropic hormone (ACTH) and cortisol levels. He was ultimately diagnosed with ectopic Cushing's syndrome (CS) secondary to new metastatic small cell lung carcinoma. About 5-10% of CS cases are caused by ectopic ACTH production. The most commonly implicated malignancies are small cell lung cancer (SCLC) and neuroendocrine tumors, with SCLC accounting for up to three-fourths of cases. ACTH production is a poor prognostic sign in SCLC, associated with more extensive disease and decreased response to first-line treatment. Tumor-associated ACTH production is often so rapid that patients do not have time to develop classic Cushingoid physical exam findings, instead presenting with acute-onset hyperglycemia, pseudohyperaldosteronism, and generalized weakness. Prompt diagnosis and treatment are essential to improve outcomes.

Keywords: Cushing’s syndrome; adrenocorticotropic hormone; endocrine paraneoplastic syndromes; hypokalemia; metabolic alkalosis.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.. A) lung window and B) mediastinal window of CT chest showing a new 6.9 cm mediastinal mass.
Figure 2.
Figure 2.. CT abdomen/pelvis showing innumerable hepatic metastatic lesions and a 5.3 cm left adrenal lesion (indicated in yellow)
Figure 3.
Figure 3.. Diagnostic algorithm to work up suspected hypercortisolemia
ACTH - adrenocorticotropic hormone, DST – dexamethasone suppression test
See this image and copyright information in PMC

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