Session: SUN 29-49-Congenital Adrenal Hyperplasia & Ectopic Cushing's
Poster Board SUN-43
Randa Al Jayoussi, Vishnu Garla MD, Christine Oakley MD.
Department of Medicine and University Eye Surgeons, Marshall University School of Medicine, Huntington, WV.
- Cushing’s syndrome is a constellation of signs and symptoms secondary to glucocorticoid excess.
- It can be ACTH dependent or ACTH independent.
- Ectopic ACTH syndrome is most commonly seen in small cell cancer of the lung and bronchial carcinoids.
- A 57 year old male patient with stage IV squamous cell cancer of the lung admitted for evaluation of hypertension and hypokalemia.
- He was diagnosed with stage IV squamous cell cancer 2 years ago and was treated with carboplatin and paclitaxel followed by radiotherapy and Erlotinib maintenance therapy .
- During the last six months the patient had numerous admissions for treatment of hypokalemia and worsening hyperglycemia.
- Physical exam was unremarkable except for a blood pressure of 171/95.
- Labs revealed persistent hypokalemia, Plasma Renin < 0.15 ng/mL/hr, Plasma aldosterone 1.0 ng/mL, Urinary metanephrines 30 pg/mL, Urinary normetanephrines 51 pg/mL, Plasma ACTH 202.6 pg/mL, Plasma cortisol 30.09, Salivary cortisol 3.9 mcg/dL and 24 hr urinary free cortisol 15,496 mcg/24hrs.
- Low dose and high dose dexamethasone suppression tests did not suppress the cortisol level.
- MRI of the brain and pituitary were normal
- The patient was diagnosed with ectopic ACTH syndrome and was treated with ketoconazole.
- The patient’s cortisol levels decreased significantly and was discharged.
- About 20 percent of ACTH dependent Cushing’s syndrome are due to ectopic ACTH syndrome
- Common causes are small cell cancer of the lung and bronchial carcinoids.
- Common clinical features include worsening hypertension, hyperglycemia and hypokalemia. Psychiatric symptoms, proximal myopathy and hyperpigmentation are also seen.
- Laboratory diagnosis is as detailed in Table 2.
- Patients with ectopic ACTH syndrome are at increased risk for recurrent infection and venous thromboembolic events.
- We suspect our patient developed ectopic ACTH syndrome as result of selection of chemo resistant cell clones which secreted ACTH.
- To our knowledge this is the only third case report describing Cushing’s syndrome secondary to squamous cell cancer of the lung.
Nothing to Disclose: RNA, VVG, HKD, CIO
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