Case-series of paraneoplastic Cushing syndrome in small-cell lung cancer

Abstract

SummaryThe objective of this study is to report three cases of paraneoplastic or ectopic Cushing syndrome, which is a rare phenomenon of the adrenocorticotropic hormone (ACTH)-dependent Cushing syndrome. Three cases are reported in respect of clinical presentation, diagnosis and treatment in addition to relevant literature review. The results showed that ectopic ACTH secretion can be associated with different types of neoplasm most common of which are bronchial carcinoid tumors, which are slow-growing, well-differentiated neoplasms with a favorable prognosis and small-cell lung cancer, which are poorly differentiated tumors with a poor outcome. The latter is present in two out of three cases and in the remaining one, primary tumor could not be localized, representing a small fraction of patients with paraneoplastic Cushing. Diagnosis is established in the setting of high clinical suspicion by documenting an elevated cortisol level, ACTH and doing dexamethasone suppression test. Treatment options include management of the primary tumor by surgery and chemotherapy and treating Cushing syndrome. Prognosis is poor in SCLC. We concluded that in front of a high clinical suspicion, ectopic Cushing syndrome diagnosis should be considered, and identification of the primary tumor is essential.Learning points:Learning how to suspect ectopic Cushing syndrome and confirm it among all the causes of excess cortisol.Distinguish between occult and severe ectopic Cushing syndrome and etiology.Providing the adequate treatment of the primary tumor as well as for the cortisol excess.Prognosis depends on the differentiation and type of the primary malignancy.

Cushing Syndrome as a Manifestation of Neuroendocrine Prostate Cancer: A Rare Presentation Within a Rare Tumor

“…Paraneoplastic CS treatment has a double approach: (1) symptomatic control with drugs promoting cortisol level normalization and (2) tumor burden reduction with chemotherapy, usually consisting of carboplatin or cisplatin plus etoposide, and/or surgery in selected patients [11,12].…”

An unusual clinical manifestation of a relapsed typical pulmonary carcinoϊd tumor

“…Neurological or neuro-endocrine para-neoplastic syndromes were noted in neuro-endocrine type tumors. Published cases presented with Cushing syndrome, limbic encephalitis and Guillain-Barre-like syndrome [ [9] , [10] , [11] ]. A paraneoplastic syndrome associated with a pulmonary TC is rare.…”

Paraneoplastic hypercortisolism : case report and review of available therapeutic options

“…En ce sens, une approche palliative est parfois souhaitable. La chimiosensibilité néoplasique est plus faible dans le cas d'un syndrome de Cushing paranéoplasique 27 .…”