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Vol.52 No.4 contents | Japanese/English |
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- Case Report -
Development of Ectopic ACTH Syndrome During Initial Chemotherapy in a Case of Small Cell Lung Cancer
Kiyoharu Fukushima1,2, Yoshiyuki Saito1, Takeshi Uenami1, Naotoshi Tsuruta1, Takashi Niju1, Toshiyuki Ikeda11Department of Respiratory Medicine, Nishinomiya Municipal Central Hospital, Japan, 2Department of General Internal Medicine, Kanagawa Prefectural Ashigara-kami Hospital, Japan
Background. Ectopic ACTH syndrome (EAS) is reported to be associated with small cell lung cancer (SCLC). Most patients are found to have EAS at the time of initial presentation or SCLC relapse, and very rarely during tumor reduction due to chemotherapy. We present here a case of SCLC in which EAS developed rapidly during effective initial chemotherapy. Case. A 74-year-old man was referred to our hospital for diagnosis and treatment of an abnormal shadow on a chest radiograph. Upon further investigation, he was given a diagnosis of SCLC (cT4N3M0 stage IIIB). Chemotherapy with carboplatin and etoposide was started and a good initial response was obtained. Two weeks after starting chemotherapy, the patient developed systemic edema and hypokalemia. Chest and abdominal computed tomography showed pleural effusion, ascites, subcutaneous edema, and bilateral enlargement of the adrenal glands, although the primary tumor and mediastinal lymph nodes had noticeably decreased in size as a result of the chemotherapy. Ectopic ACTH syndrome was diagnosed on the basis of endocrinological data. Subsequently, he developed pneumonia and died from respiratory failure. The supraclavicular lymph node was biopsied after death, and ACTH secretion from the SCLC was confirmed immunohistologically. Conclusion. This case indicates that EAS may develop rapidly in cases of SCLC even if the tumor size has decreased due to chemotherapy. Clinicians should be cognizant of the clinical symptoms of EAS when treating patients with SCLC.
key words: Small cell lung cancer, Ectopic ACTH syndrome, Cushing's syndrome, Chemotherapy, Edema
Received: March 19, 2012
Accepted: June 11, 2012
JJLC 52 (4): 387-392, 2012
