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Ectopic adrenocorticotrophic hormone production and neoplasm
Australian and New Zealand Journal of Medicine
|June 1, 1975
Summary
Patients with neoplasms experienced severe electrolyte imbalances and skin changes due to elevated cortisol. Aminoglutethamide therapy helped reduce cortisol levels in these cases.
Area of Science:
- Endocrinology
- Oncology
- Nephrology
Background:
- Neoplasms can secrete hormones, leading to complex clinical syndromes.
- Cushing's syndrome is characterized by excessive cortisol production.
- Electrolyte imbalances, such as hypokalemia and hypochloremia, can have significant systemic effects.
Observation:
- Three patients presented with severe hypokalemic, hypochloremic alkalosis, muscle weakness, and cutaneous pigmentation.
- Clinical signs of Cushing's syndrome were minimal despite hormonal abnormalities.
- Two patients had bronchial neoplasms, and one had a pancreatic neoplasm.
Findings:
- Extremely elevated plasma cortisol and urinary steroid metabolites were observed.
- Synacthen stimulation tests indicated significant adrenal capacity, even with adrenal metastases.
- Aminoglutethamide administration resulted in reduced plasma cortisol levels in two patients.
Implications:
- This suggests ectopic ACTH production from neoplasms as a cause of pseudo-Cushing's syndrome.
- Early recognition and management of hormonal imbalances are crucial in patients with neoplasms.
- Pharmacological interventions targeting cortisol synthesis can be effective in managing these complex cases.