Endocrine Abstracts

A 44-year-old lady with hypertension and type 2 diabetes of 10 years duration (BMI 47, HbA1c 9.1%) treated with metformin and exenatide presented with a few days history of feeling generally unwell, vomiting and confusion. Initial examination showed pulse 120 per min, BP 115/74 mmHg, normal temperature and multiple abdominal striae. Admission investigations showed Na 140, K 1.4, urea 3.9, creatinine 74, glucose 26, CRP 23 Hb 16.2, WBC 11.6. ABGS on room air showed pH 7.41, PCO₂ 3.5, PaO₂ 11.0. She was initially treated with intravenous KCl and received a total of 280 mmol in the first 48 h. On day 2 the potassium improved only to 2.4 but she developed evidence of sepsis (temp 39 ° C) and metabolic acidosis (pH 7.08). She was treated in ITU with IV antibiotics. Random cortisol came back at 2712 nmol/l with ACTH 50 pmol/l. Pituitary MRI was normal while CT of chest, abdomen and pelvis showed a bulky left adrenal gland and two focal liver lesions suggestive of metastasis but no primary tumour detected. A liver biopsy was eventually performed which showed a poorly differentiated large cell neuroendocrine carcinoma. The patient had a stormy hospital stay complicated by severe sepsis, DVT, C. Difficile diarrhea and acute renal failure needing haemofiltration. She died after 6 weeks stay in ITU. Metastatic neuroendocrine tumours causing ectopic Cushing’s syndrome are rare and as illustrated in this case these tumours can be very aggressive and have a very poor prognosis.