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): 1213-1220
Published online May 26, 2019. doi: 10.12998/wjcc.v7.i10.1213
Small cell lung cancer starting with diabetes mellitus: Two case reports and literature review
Tong Zhou, Yao Wang, Xue Zhao, Yang Liu, Ying-Xuan Wang, Xiao-Kun Gang, Gui-Xia Wang
Tong Zhou, Xue Zhao, Ying-Xuan Wang, Xiao-Kun Gang, Gui-Xia Wang, Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Jilin University, Changchun 130021, Jilin Province, China
Yao Wang, Department of Orthopedics, The Second Hospital of Jilin University, Jilin University, Changchun 130041, Jilin Province, China
Yang Liu, Department One of The Health Careful VIP, Jilin Provincial People's Hospital, Changchun 130000, Jilin Province, China
Author contributions: Zhou T, Wang GX and Gang XK conceived the study; Wang Y, Liu Y and Wang YX collected the human documents; Zhou T, Gang XK and Zhao X wrote the paper.
Supported by Development and Reform Commission Jilin Province, NO. 2017C019; and Science and Technology Agency of Jilin Province, No. 20170623092TC-01 and No. 20180623083TC-01.
Informed consent statement: Informed consent was obtained from patients regarding the use of specimens for case report.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The guidelines of the CARE Checklist (2016) have been adopted.
Open-Access: This article is an open-access article that 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: Gui-Xia Wang, MD, PhD, Professor, Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Jilin University, 71 Xinmin Street, Changchun 130021, Jilin Province, China. gwang168@jlu.edu.cn
Telephone: +86-431-88782557 Fax: +86-431-88782557
Received: January 24, 2019
Peer-review started: January 25, 2019
First decision: March 9, 2019
Revised: March 17, 2019
Accepted: March 26, 2019
Article in press: March 26, 2019
Published online: May 26, 2019
Abstract
BACKGROUND

Small-cell lung cancer (SCLC) is a type of fatal tumor that is increasing in prevalence. While these are unpleasant facts to consider, it is vitally important to be informed, and it is important to catch the disease early. Typically, lung cancer does not show severe clinical symptoms in the early stage. Once lung cancer has progressed, patients might present with classical symptoms of respiratory system dysfunction. Thus, the prognosis of SCLC is closely related to the early diagnosis of the disease. Ectopic adrenocorticotropic hormone (ACTH) syndrome (EAS) is related to cancer occurrence, especially for SCLC with the presence of Cushing's syndrome, which is dependent on markedly elevated ACTH and cortisol levels.

CASE SUMMARY

In the current report, we describe two middle-age patients who were originally diagnosed with diabetes mellitus with no classical symptoms of lung cancer. The patients were eventually diagnosed with SCLC, which was confirmed by bronchoscopic biopsy and histopathology. SCLC-associated diabetes was related to EAS, which was an endogenous ACTH-dependent form of Cushing’s syndrome with elevated ACTH and cortisol levels. Multiple organ metastases were found in Patient 1, while Patient 2 retained good health at 2 years follow-up. EAS symptoms including thyroid dysfunction, hypercortisolism and glucose intolerance were all resolved after anticancer treatment.

CONCLUSION

In conclusion, SCLC might start with diabetes mellitus and increased cortisol and hypokalemia or other EAS symptoms. These complex clinical features were the most significant factors to deteriorate a patient’s condition. Early diagnosis and treatment from clinicians were essential for the anti-cancer treatment for patients with SCLC.

Keywords: Case report, Small cell lung cancer, Diabetes, Ectopic adrenocorticotropic hormone syndrome, Adrenocorticotropic hormone, Diagnosis

Core tip: Small-cell lung cancer (SCLC) is a fatal tumor that is increasing in prevalence. Prognosis of patients with SCLC is closely related to early diagnosis. We report two middle-aged patients who were originally diagnosed with diabetes mellitus with no classical symptoms of lung cancer. Ectopic adrenocorticotropic hormone syndrome symptoms including thyroid dysfunction, hypercortisolism, and glucose intolerance, which are related to elevated adrenocorticotropic hormone and cortisol levels, were all normal after anticancer treatment. Our findings highlight that SCLC might start with diabetes mellitus and increased cortisol level and hypokalemia or other ectopic adrenocorticotropic hormone syndrome symptoms, and it reminds clinicians of the importance of early diagnosis of SCLC with ectopic adrenocorticotropic hormone syndrome.