Stage IV Small Cell Lung Cancer Causing Severe Cushing Syndrome

This lung cancer diagnosis at a glance

Stage at diagnosis
Stage IV
Subtype
Small Cell Lung Cancer
Biomarkers
Ectopic ACTH secretion with markedly elevated ACTH and cortisol
Sex
Male
Spread to
liver|bones
Treatment
chemotherapy and radiation
Outcome
In Memory

Treatment course, step by step

  1. Six cycles of carboplatin and etoposide reduced the tumor and controlled ACTH and cortisol.
  2. After progression at 7 months, he received 4 cycles of topotecan, 2 further carboplatin and etoposide cycles, and 1 carboplatin and paclitaxel cycle.
  3. He also received prophylactic cranial irradiation.

What happened, in summary

A 42-year-old former smoker presented with chest pain, breathlessness, fatigue, leg swelling, facial darkening, and rapid weight gain. He had severe high blood pressure, metabolic alkalosis, and a potassium level of 1.9 mmol/L. Imaging showed a left hilar lung mass, multiple liver lesions, and later osteolytic bone metastases. The cancer was Stage IV small cell lung cancer producing ectopic ACTH, causing severe Cushing syndrome.

Metyrapone, potassium replacement, and blood-pressure medicines were started to control the hormone effects. Six cycles of carboplatin and etoposide reduced the tumor and brought ACTH and cortisol much closer to normal. Scans initially showed stable primary and metastatic disease.

After 7 months, the lung tumor, liver lesions, and bone disease progressed and the hormone syndrome worsened. Further treatment included 4 cycles of topotecan, 2 more cycles of carboplatin and etoposide, 1 cycle of carboplatin and paclitaxel, and prophylactic cranial irradiation. His condition continued to decline, and he died after cardiopulmonary arrest 1 year after diagnosis.

Where this story comes from

This is a lay summary of an account first published by PMC / PubMed Central. Read the original in full

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