CUSHING'S SYNDROME SECONDARY TO SQUAMOUS CELL CANCER OF THE LUNG: A CASE REPORT

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 29-49-Congenital Adrenal Hyperplasia & Ectopic Cushing's
Clinical
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-43
Randa Nazem Al-jayoussi*1, Vishnu Vardhan Garla2, Henry Keane Driscoll3 and Christine Irene Oakley4
1Joan C Edwards School of Medicine at Marshall University, Huntington, WV, 2Univeristy Physicians & Surgeons, Huntington, WV, 3Marshall Univ Sch of Med, Huntington, WV, 4Joan C Edwards School of Medicine at Marshall university, Huntington, WV
CUSHINGS SYNDROME SECONDARY TO SQUAMOUS CELL CANCER OF THE LUNG: A CASE REPORT.

Randa Al Jayoussi, Vishnu Garla MD, Christine Oakley MD.

Department of Medicine and University Eye Surgeons, Marshall University School of Medicine, Huntington, WV.

 

 Background:

  • 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.

 

Case report:

  • 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.

Discussion:

  • 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.

Conclusion:

  • To our knowledge this is the only third case report describing Cushing’s syndrome secondary to squamous cell cancer of the lung.

1)Isidori AM, Lenzi A. Ectopic ACTH syndrome. Arq Bras Endocrinol Metabol. 2007; 51:1217-1225.2)Alexandraki KI, Grossman AB. The ectopic ACTH syndrome. Rev Endocr Metab Disord. 2010; 11:117-126.

Nothing to Disclose: RNA, VVG, HKD, CIO

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