Paraneoplastic Hypertension and Lung Cancer

In our #AMreport this week at@WCHospital, we reviewed a case of  a patient presenting with diastolic hypertension and hypokalemia and later found to have pulmonary nodules consistent with a diagnosis of small cell lung cancer.  About 25% of all cases of ectopic ACTH production is due to small cell lung cancer [1].
 #AMreport 5 take home points:
  1. Lung cancer is divided into two main histological categories, non-small cell lung cancer  (NSCLC) and small cell lung cancer (SCLC) accounting for 85% and 15% of cases respectively.
  2. SCLC can result in many paraneoplastic syndromes including:
    • SIADH → hyponatremia
    • Ectopic ACTH → Cushing’s
    • Neurologic syndromes → cerebellar degeneration, optic neuritis, Lambert-Eaton syndrome.
  3. Usually, ectopic ACTH production has high ACTH levels (>20 ng/L) and cortisol levels are not be suppressed with high doses of dexamethasone ~ 8mg.
  4. Management of patients with ectopic ACTH centres around controlling hypercortisolism as soon as the diagnosis has been established with ketoconazole and metyrapone being the agents of choice.
  5.  Amongst all tumour related causes for ectopic ACTH, patients with SCLC carry a poor prognosis, with median survival of 6-8 months.






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