- A Case of Ectopic ACTH Syndrome Associated with Small Cell Lung Cancer Presented with Hypokalemia.
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Hong Jun Yang, Hea Jung Sung, Ji Eun Kim, Hyo Jin Lee, Jin Min Park, Chan Kwon Park, Eun Suk Roh, Jae Hyung Cho, Seung Hyun Ko, Ki Ho Song, Yu Bai Ahn
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J Korean Endocr Soc. 2007;22(5):359-364. Published online October 1, 2007
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DOI: https://doi.org/10.3803/jkes.2007.22.5.359
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- We report a case of a 73-year-old female patient who was diagnosed with ectopic ACTH syndrome caused by small cell lung cancer. We initially presumed that the patient was in a state of mineralocorticoid excess, because she had hypertension and hypokalemic alkalosis. This was however excluded because her plasma renin activity was not suppressed and her plasma aldosterone/plasma renin activity ratio was below 25. Moreover, her 24 hour urine free cortisol level was elevated and her serum cortisol levels after a low dose dexamethasone suppression test, were not suppressed. Furthermore, her basal plasma ACTH and serum cortisol levels increased and her serum cortisol level after a high dose dexamethasone suppression test was not suppressed. We performed studies to identify the source of ectopic ACTH syndrome and found a 3 cm-sized mass in the patient's right lower lobe of her lung, which was eventually diagnosed as small cell lung cancer following a bronchoscopic biopsy. In conclusion, Cushing's syndrome, and in particular ectopic ACTH syndrome, must be considered in the differential diagnosis of mineralocorticoid-induced hypertension. The excessive cortisol saturates the 11beta-hydroxysteroid dehydrogenase type 2 (11beta-HSD2) activity, which in turn, inactivates the conversion of cortisol to cortisone in the renal tubules. Moreover, excessive cortisol causes binding to the mineralocorticoid receptors, causing mineralocorticoid hypertension, characterized by severe hypercortisolism.
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Citations
Citations to this article as recorded by  - Emergencia hipertensiva como debut de síndrome de Cushing paraneoplásico
E. Rubio González, M. de Valdenebro Recio, M.I. Galán Fernández
Hipertensión y Riesgo Vascular.2024; 41(2): 135. CrossRef - Management of small cell lung cancer complicated with paraneoplastic Cushing’s syndrome: a systematic literature review
Yanlong Li, Caiyu Li, Xiangjun Qi, Ling Yu, Lizhu Lin
Frontiers in Endocrinology.2023;[Epub] CrossRef - Ectopic Cushing Syndrome in Adenocarcinoma of the Lung: Case Report and Literature Review
Rana Al-Zakhari, Safa Aljammali, Basma Ataallah, Svetoslav Bardarov, Philip Otterbeck
Cureus.2021;[Epub] CrossRef - A Case of Ectopic Adrenocorticotropic Hormone Syndrome in Small Cell Lung Cancer
Chaiho Jeong, Jinhee Lee, Seongyul Ryu, Hwa Young Lee, Ah Young Shin, Ju Sang Kim, Joong Hyun Ahn, Hye Seon Kang
Tuberculosis and Respiratory Diseases.2015; 78(4): 436. CrossRef
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