Endocrine Abstracts

• A 54-year old Lithuanian man presented with symptomatic hyperglycaemia and weight loss.

• A diagnosis of new onset diabetes type 2 was confirmed for which he received treatment. In addition, his serum potassium remained low despite of intervention.

• CXR was done and showed a bulky right sided hilar mass.

• The combination of refractory hypokalaemia, hyperglycaemia, and lung cancer suspicion led to endocrinology review. Suggestion was made that these findings could be secondary to hypercortisolism.

• A corticotrophin-releasing hormone (CRH) test was performed as a differential diagnosis of adrenocorticotropic hormone (ACTH) dependent Cushing’s syndrome.

• Supraclavicular node biopsy showed an undifferentiated small cell cancer of lung origin. L1 vertebral body fracture and extensive metastatic disease was also seen on the MRI scan.

• Oncology review concluded poor prognosis and suggested palliative chemotherapy.

• The patient eventually expired in the hospital.

• This highlights the vitality in recognising the evolving clinical manifestations of paraneoplastic disease and seek specialist advice appropriately and urgently.

• He presented with two weeks history of polydipsia, polyuria, lethargy and weight loss. Otherwise, fit and well and independently mobile.

• He worked in a supermarket factory and lived at home with his partner.

• As both of them did not speak English, a collateral history was taken from his cousin.

• On admission capillary blood glucose (CBG) was 34.1 mmol/l (normal ref: 4-8 mmol/l).

• Further blood tests showed hypokalaemia K+ 2.6 mmol/l (ref: 3.5-5.3 mmol/l), and mildly elevated white cells 12.39 10*9/l (ref: 4.0-11.0) and neutrophils 9.87 10*9/l (ref: 2- 7.5).

• Physical examination and the rest of blood tests were unremarkable.