11
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Dual paraneoplastic syndromes in a patient with small cell lung cancer: a case report

      research-article
      1 , 1 , , 1
      Journal of Medical Case Reports
      BioMed Central

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Introduction

          We describe the case of a patient with small cell lung cancer and dual paraneoplastic syndromes involving adrenocorticotropic hormone and calcitonin. To the best of our knowledge, dual paraneoplastic syndromes involving these two hormones have not been previously reported in the literature.

          Case presentation

          A 74-year-old Caucasian woman presented with a left hilar mass and metastatic disease in the liver and right adrenal gland. The patient complained only of intermittent diarrhea. Her laboratory values exhibited metabolic alkalosis with hypokalemia, hypocalcemia, hypomagnesemia, hypophosphatemia, and hyperglycemia.

          Conclusion

          We discuss the work-up and treatment of the patient's unusual laboratory presentation with two concurrent paraneoplastic syndromes.

          Related collections

          Most cited references9

          • Record: found
          • Abstract: found
          • Article: not found

          Paraneoplastic syndromes associated with small cell lung cancer.

          Small cell lung cancer (SCLC) is the most frequent cancer histology associated with paraneoplastic syndromes. These syndromes are typically caused by ectopic hormone production or immune-mediated tissue destruction caused by neural antigen expression from cancer cells. This antigen expression induces the production of antibodies that cross-react with neural tissue. This article discusses the most common ectopic hormone and neurologic paraneoplastic syndromes and emphasizes the relationships among antigens, clinical syndromes, and outcomes. Although ectopic hormone production has been associated with extensive-stage disease and a poorer outcome, the antibody-mediated paraneoplastic syndromes are prognostic factors associated with more favorable outcomes. Both have the potential for improvement with cancer treatment.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Ketoconazole in the management of paraneoplastic Cushing's syndrome secondary to ectopic adrenocorticotropin production.

            To evaluate the safety and efficacy of ketoconazole treatment in the management of patients with paraneoplastic Cushing's syndrome (CS) secondary to ectopic adrenocorticotropin (ACTH) production by malignant neoplasms (ECS). A retrospective chart review was undertaken for 15 consecutive patients with ECS treated with ketoconazole. Strict criteria were defined for diagnosis of ECS and for clinical, biochemical, and hormonal responses. There were four women and 11 men with a median age of 59 years (range, 44 to 84). Eleven patients had primary lung cancer (nine small-cell [SCLC], one mixed SCLC/non-SCLC, and one non-SCLC); two had carcinoid tumors (one bronchial, one pancreatic); one had hepatocellular carcinoma; and one had medullary carcinoma of the thyroid. Eight patients had ECS diagnosed at tumor presentation. Clinical findings included proximal muscle weakness (n = 10), peripheral edema (n = 8), and hypertension (n = 8). Biochemical abnormalities included hypokalemia (n = 14), metabolic alkalosis (n = 13), and new or worsened diabetes mellitus (n = 10). Patients received ketoconazole in dosages of 400 to 1,200 mg/d titrated by changes in urinary free-cortisol (UFC) levels for a median duration of 26 days (range, 3 to 1,059), and nine also received chemotherapy with ketoconazole. Hypokalemia, metabolic alkalosis, diabetes mellitus, and hypertension improved in the majority of patients. Ten patients had a hormonal response, with seven complete responses (median duration, 25 days; range, 6 to 989). The occurrence of symptomatic hypoadrenalism was definite in three patients and probable in one. Most patients died of progressive malignant disease accompanied by escape from hormonal control by ketoconazole. The median survival duration of the group was 19 weeks (range, 1 to 154). Ketoconazole results in biochemical and hormonal improvement for most patients with ECS. It has few adverse effects, but may impair the cortisol response to stress. For that reason, replacement corticosteroids should be considered for patients with hormonal response, and moderate- to high-dose corticosteroids should be given for any potential stress situations. The ultimate control of the syndrome is dependent on successful treatment of the underlying tumor.
              Bookmark
              • Record: found
              • Abstract: not found
              • Article: not found

              Uncommon presentations of some common malignancies: Case 1. Sequential paraneoplastic endocrine syndromes in small-cell lung cancer.

                Bookmark

                Author and article information

                Journal
                J Med Case Reports
                Journal of Medical Case Reports
                BioMed Central
                1752-1947
                2011
                19 July 2011
                : 5
                : 318
                Affiliations
                [1 ]Bethesda Family Medicine Residency Program, 4411 Montgomery Road, Suite 200, Cincinnati, OH 45212, USA
                Article
                1752-1947-5-318
                10.1186/1752-1947-5-318
                3158120
                21771301
                7ece4062-825d-46a3-8fec-54462bca21f2
                Copyright ©2011 Coners et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 20 September 2010
                : 19 July 2011
                Categories
                Case Report

                Medicine
                Medicine

                Comments

                Comment on this article