[Deleterious course in tumor patients with ectopic ACTH secretion and secondary Cushing's syndrome]

Ectopic ACTH secretion with secondary Cushing's syndrome was observed in two patients with metastatic islet cell carcinoma and oat cell carcinoma of the lung respectively. Both patients were young (27 and 31 years), male, and developed severe hypokalemia, metabolic alkalosis and hypertension. Besides excessively increased ACTH-secretion, increased free urinary cortisol, 17-hydroxy- and 17-ketosteroids were found. The dexamethasone suppression test was negative. Inhibitors of adrenal steroid synthesis (aminoglutethimide, trilostan, o,p'-DDD) did not significantly change cortisol secretion and hypokalemia, and clinical symptoms persisted. Radiotherapy (5000 cGy) resulted in a partial remission of short duration in one patient. Both patients, however, died of metabolic complications 2 and 8 months after the diagnosis of Cushing's syndrome.