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.