Hypertension and severe hypokalaemia associated with ectopic ACTH production

Ectopic adrenocorticotropic hormone (ACTH) secretion represents 5%–10% of cases of Cushing’s syndrome (CS), and approximately 50%–60% of these arise from neuroendocrine lung tumours, including small-cell lung cancer (SCLC). We report a 42-year-old man admitted with hypertension, metabolic alkalosis...

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Bibliographic Details
Published in:	BMJ case reports Vol. 2018; p. bcr-2017-223406
Main Authors:	Lobo Ferreira, Tiago, Nunes da Silva, Tiago, Canário, Dolores, Francisca Delerue, Maria
Format:	Journal Article
Language:	English
Published:	England BMJ Publishing Group LTD 16-08-2018 BMJ Publishing Group
Series:	Case Report
Subjects:	ACTH Syndrome, Ectopic - complications ACTH Syndrome, Ectopic - diagnosis ACTH Syndrome, Ectopic - physiopathology Adrenocorticotropic Hormone - blood Adrenocorticotropic Hormone - metabolism Adult Biomarkers, Tumor - blood Blood pressure Cancer therapies Case reports Chemotherapy Cushing syndrome Cushing Syndrome - complications Cushing Syndrome - diagnosis Edema Fatal Outcome Hormones Humans Hydrocortisone - blood Hydrocortisone - urine Hypertension Hypertension - etiology Hypokalemia Hypokalemia - blood Hypokalemia - complications Liver Lung cancer Lung Neoplasms - complications Lung Neoplasms - diagnosis Lung Neoplasms - pathology Male Medical diagnosis Medical imaging Medical prognosis Metabolism Metastasis Obesity, Abdominal - complications Patients Potassium Reminder of Important Clinical Lesson Small Cell Lung Carcinoma - complications Small Cell Lung Carcinoma - diagnosis Small Cell Lung Carcinoma - pathology Thromboembolism Tomography, X-Ray Computed Tumors Ultrasonic imaging Whole Body Imaging Portugal emergency medicine fluid electrolyte and acid-base disturbances endocrinology lung cancer (oncology)
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Summary:	Ectopic adrenocorticotropic hormone (ACTH) secretion represents 5%–10% of cases of Cushing’s syndrome (CS), and approximately 50%–60% of these arise from neuroendocrine lung tumours, including small-cell lung cancer (SCLC). We report a 42-year-old man admitted with hypertension, metabolic alkalosis and severe hypokalaemia. On physical examination, centripetal obesity with ‘moon face’ and ‘buffalo’s hump’ were identified, and wheezing on left lung was heard. A markedly elevated serum cortisol, ACTH and urine free cortisol production supported the diagnosis of CS. Chest CT showed a left hilar mass with metastasis to the liver, adrenal glands and lymph nodes. Bronchoscopy identified bronchial infiltration by SCLC. Treatment with metyrapone and chemotherapy was started. Despite initial improvement, progressive clinical deterioration occurred, culminating in death 1 year after diagnosis. Ectopic ACTH secretion is uncommon but should be suspected in patients with severe hypokalaemia, hypertension and metabolic alkalosis, especially in the context of lung cancer.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3
ISSN:	1757-790X 1757-790X
DOI:	10.1136/bcr-2017-223406