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CASE REPORT
Hypertension and severe hypokalaemia associated with ectopic ACTH production
  1. Tiago Lobo Ferreira1,
  2. Tiago Nunes da Silva2,
  3. Dolores Canário3,
  4. Maria Francisca Delerue1
  1. 1Internal Medicine Department, Hospital Garcia de Orta, Almada, Portugal
  2. 2Endocrinology Department, Hospital Garcia de Orta, Almada, Portugal
  3. 3Pneumology Department, Hospital Garcia de Orta, Almada, Portugal
  1. Correspondence to Dr Maria Francisca Delerue, mdelerue{at}hgo.min-saude.pt

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.

  • emergency medicine
  • endocrinology
  • lung cancer (oncology)
  • fluid electrolyte and acid-base disturbances
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Footnotes

  • TLF and TNS contributed equally.

  • Contributors TLF and TNdS designed the work and drafted the manuscript. Both authors contributed equally to this manuscript. DC was the main responsible for the patient’s follow-up and reviewed the case. MFD coordinated the team and reviewed the manuscript. All authors approved the final version of the manuscript.

  • 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.

  • Patient consent Next of kin consent obtained.

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

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