Tuberc Respir Dis.  2015 Oct;78(4):436-439. 10.4046/trd.2015.78.4.436.

A Case of Ectopic Adrenocorticotropic Hormone Syndrome in Small Cell Lung Cancer

• Jeong C
• Lee J
• Ryu S
• Lee HY
• Shin AY
• Kim JS
• Ahn JH
• Kang HS

• KMID: 2320723
• DOI: http://doi.org/10.4046/trd.2015.78.4.436

Abstract

Small cell lung cancer (SCLC), which originated from neuroendocrine tissue, can develop into paraneoplastic endocrine syndromes, such as Cushing syndrome, because of an inappropriate secretion of ectopic adrenocorticotropic hormone (ACTH). This paraneoplastic syndrome is known to be a poor prognostic factor in SCLC. The reason for poor survival may be because of a higher risk of infection associated with hypercortisolemia. Therefore, early detection and appropriate treatment for this syndrome is necessary. But the diagnosis is challenging and the source of ACTH production can be difficult to identify. We report a 69-year-old male patient who had severe hypokalemia, metabolic alkalosis, and hypertension as manifestations of an ACTH-secreting small cell carcinoma of the lung. He was treated with ketoconazole and spironolactone to control the ACTH dependent Cushing syndrome. He survived for 15 months after chemotherapy, which is unusual considering the poor outcome of the ectopic ATH syndrome associated with SCLC.

Keyword

ACTH Syndrome, Ectopic; Small Cell Lung Carcinoma; Paraneoplastic Syndromes

MeSH Terms

ACTH Syndrome, Ectopic
Adrenocorticotropic Hormone*
Aged
Alkalosis
Carcinoma, Small Cell
Cushing Syndrome
Diagnosis
Drug Therapy
Humans
Hypertension
Hypokalemia
Ketoconazole
Lung
Male
Paraneoplastic Endocrine Syndromes
Paraneoplastic Syndromes
Small Cell Lung Carcinoma*
Spironolactone
Adrenocorticotropic Hormone
Ketoconazole
Spironolactone

Figure

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  Figure 1 Chest radiography showed an ill-defined mass at the left hilum suggesting a mass involving the left upper bronchus with marked atelectasis of the left upper lobe.

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  Figure 2 (A, B) Contrast enhanced computed tomography of the chest revealed 7×5-cm-sized mass in the left upper lobe with probable invasion of the main pulmonary arterial trunk and pericardium.

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  Figure 3 (A) Microscopic images of small cell lung cancer obtained with bronchoscopy biopsy (H&E stain, ×200). (B) Immunostain for ACTH demonstrated a strong positive staining in the tumor (×200).

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