Endocrine Abstracts

Introduction: Ectopic Cushing’s syndrome caused by ectopic ACTH secretion are under-diagnosed.

Case report: A 50 years old male patient is hospitalized for severe hypokalaemia and diabetes. Last 6 months he had a history of chest pain, prolonged cough, general weakness, difficulties climbing stairs, confusion, loss of consciousness. Previously, he was hospitalized in psychiatric hospital for psychotic alterations, in cardiology for high blood pressure and cardiomyopathy (Ef 40%). Type 2 diabetes is diagnosed before 3 months; treated with basal insulin. Initial investigations revealed Na 144 mmol/l (135–145), K⁺ 1.9 mmol/l (3.5–5.2), Urea 9 mmol/l, Cr(s) 47 mmol/l, Glu(s) 9 mmol/l. DXA confirmed osteoporosis (T-score >−2.5). Basal cortisol 1300 nmol/l, Daily rhythm of cortisol during 24 h was >1750 nmol/l. ACTH 641.2 pg/ml (7.2–63.6). On chest x ray it was suspicious tumoral mass, confirmed with chest CT. Tumor mass was present on upper mediastinum to the left until hilus, enlarged mediastinal lymph nodes, infiltration on the left lobe and pleural effusion in the same part. Gas analysis: partialy manifested respiratory insufficiency. Endoscopic bronchoscopy with ultrasound (EBUS) was performed for cyto/immunocytochemical analysis for ACTH. Citologycaly confirmed IV classification group of malignancy – oat cell carcinoma and immunocytochemy for ACTH was positive in 5–10% of neoplastic cells and positive for chromogranin in 30–40% and NSE in 50–60% of tumoral population. Patient was referred to Clinic of Pulmology and Institute of Oncology.

Conclusion: Diagnosis of ectopic Cushing’s syndrome explain other co-morbidities such as hypokalaemia, diabetes, osteoporosis, psychosis. Appropriate diagnostic procedures without additional tests (dexamethasone suppression test, MRI), accelerates the diagnosis of this life-threatening patient.