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Ectopic ACTH secretion from a metastatic gastric carcinoma with neuroendocrine component
  1. Annalisa Montebello,
  2. Darryl Portelli and
  3. Mark Gruppetta
  1. Department of Diabetes and Endocrinology, Mater Dei Hospital, Msida, Malta
  1. Correspondence to Dr Annalisa Montebello; a.montebello{at}


An elderly gentleman was admitted to hospital with severe hypokalaemia of 1.75mmol/L. A background of a recently diagnosed metastatic gastric carcinoma with a neuroendocrine component pointed towards the diagnosis of ectopic ACTH secretion causing this dangerous electrolyte imbalance. He was treated with aggressive potassium supplementation and the adrenal steroid synthesis blocker metyrapone to acutely control his Cushing’s syndrome. Chemotherapy consisting of carboplatin/etoposide combination was initiated but unfortunately the patients’ health deteriorated, and he died three months after his initial diagnosis. This case highlights the accelerated presentation of hypercortisolism due to ectopic ACTH secretion. It discusses the classification of neuroendocrine tumours and their varied prognosis depending on the underlying tumour grade. It emphasises the importance of having a multidisciplinary team to be able to care for two underlying pathologies simultaneously: both the severe hypercortisolism and his metastatic gastric tumour.

  • adrenal disorders
  • drugs: endocrine system
  • stomach and duodenum
  • endocrine cancer

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  • Contributors AM and DP wrote up the case with the constant support and guidance from MG.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.