Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2019; 7(10): 1177-1183
Published online May 26, 2019. doi: 10.12998/wjcc.v7.i10.1177
Small cell lung cancer with panhypopituitarism due to ectopic adrenocorticotropic hormone syndrome: A case report
Ting Jin, Fang Wu, Shui-Ya Sun, Fen-Ping Zheng, Jia-Qiang Zhou, Yi-Ping Zhu, Zhou Wang
Ting Jin, Fang Wu, Shui-Ya Sun, Fen-Ping Zheng, Jia-Qiang Zhou, Zhou Wang, Department of Endocrinology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou 310016, Zhejiang Province, China
Yi-Ping Zhu, Department of General Surgery, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou 310016, Zhejiang Province, China
Author contributions: All the authors materially participated in this work and have read and approved the final manuscript; Jin T is the first authors for this study; Wang Z is the corresponding author supervising this work; Jin T and Wu F managed the case and drafted the manuscript; Jin T, Wu F and Sun SY performed analysis on all data interpretation from literature review; Zheng FP, Zhou JQ, Zhu YP and Wang Z reviewed the manuscript; we acknowledge that all authors participated sufficiently in the work and take public responsibility for its content.
Supported by the National Science Foundation for Youth, No. 30800533; and the Public Welfare Project of Science and Technology Department of Zhejiang Province, China, No. 2017C33056.
Informed consent statement: Written consent was obtained from the patient. The patient consented to the publication of medical data (including figures from diagnostic imaging results and from histological examination results).
Conflict-of-interest statement: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
CARE Checklist (2016) statement: This report follows the guidelines of the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Zhou Wang, MD, Professor, Department of Endocrinology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, 3 East Qing Chun Road, Hangzhou 310016, Zhejiang Province, China. 3405008@zju.edu.cn
Telephone: +86-571-86006176 Fax: +86-571-86006176
Received: December 29, 2018
Peer-review started: December 29, 2019
First decision: March 10, 2019
Revised: March 29, 2019
Accepted: April 9, 2019
Article in press: April 9, 2019
Published online: May 26, 2019
Processing time: 148 Days and 20.4 Hours
Abstract
BACKGROUND

Small cell lung cancer (SCLC) accounts for 15% of lung cancers, and it commonly expresses peptide and protein factors that are active as hormones. These secreting factors manifest as paraneoplastic disorders, such as ectopic adrenocorticotropic hormone (ACTH) syndrome (EAS). The clinical features are abnormalities in carbohydrate metabolism, hypokalemia, peripheral edema, proximal myopathy, hypertension, hyperpigmentation, and severe systemic infection. However, it is uncommon that EAS has an influence on hypothalamus-pituitary function.

CASE SUMMARY

A 62-year-old man presented with complaints of haemoptysis, polyuria, polydipsia, increased appetite, weight loss, and pigmentation. Following a series of laboratory and imaging examinations, he was diagnosed with SCLC, EAS, hypogonadism, hypothyroidism, and central diabetes insipidus. After three rounds of chemotherapy, levels of ACTH, cortisol, thyroid hormone, gonadal hormone, and urine volume had returned to normal levels. In addition, the pulmonary tumor was reduced in size.

CONCLUSION

We report a rare case of SCLC complicated with panhypopituitarism due to EAS. We hypothesize that EAS induced high levels of serum glucocorticoid and negative feedback for the synthesis and secretion of antidiuretic hormone from the paraventricular nucleus, and trophic hormones from the anterior pituitary. Therefore, patients who present with symptoms of hypopituitarism, or even panhypopituitarism, with SCLC should be evaluated for EAS.

Keywords: Small cell lung cancer; Ectopic adrenocorticotropic hormone syndrome; Panhypopituitarism; Case report

Core tip: Ectopic adrenocorticotropic hormone syndrome (EAS) is the common paraneoplastic disorder in patients with small cell lung cancer (SCLC). However, it is uncommon that EAS has an influence on hypothalamus-pituitary function. Here, we report a rare case of SCLC complicated with panhypopituitarism due to EAS. We hypothesize that EAS induced high levels of serum glucocorticoid and negative feedback for the synthesis and secretion of antidiuretic hormone from the paraventricular nucleus, and trophic hormones from the anterior pituitary.