Paraneoplastisch syndroom van Cushing

Abstract

Paraneoplastic Cushing’s syndrome Introduction. Paraneoplastic Cushing’s syndrome (ECS) is a rare condition which is related to an ectopic adrenocorticotropic hormone (ACTH) or, rarely, corticotropin-releasing hormone (CRH) production. Diverse tumours can cause ECS; small-cell lung cancer (SCLC) and bronchial carcinoids account for the majority of the cases. In this report, the medical history of a patient with ECS due to SCLC is presented. The main purpose of this case-report is to outline the difficult clinical presentation. Case description. A 72-year-old cachectic man was diagnosed with SCLC. The coexistence of hypokalemia and hyperglycemia raised the suspicion of ECS, which was confirmed by high levels of plasma cortisol, plasma ACTH and urinary cortisol. Discussion. The diagnostic process of Cushing’s syndrome is outlined. Conclusion. The diagnosis of ECS can be challenging since typical clinical symptoms may be absent. Hypokalemia or hyperglycemia in a context of SCLC or a neuro-endocrine tumour (NET) should prompt further evaluation with determination of the plasma cortisol and ACTH.