Endocrine Abstracts

We describe the presentation of a 65 years old lady with upper gastrointestinal bleed to Altnagelvin Area Hospital in April 2023, eventually diagnosed with Cushing’s syndrome due to ectopic ACTH secretion from a high grade neuroendocrine tumor. Acute presentation was preceded by three months of general decline, weight loss, poor appetite and a history of smoking 20 cigarettes per day for more than 20 years. On examination, she was cachectic and delirious with cutaneous nodules in the thorax, anterior abdominal wall and the left gluteal region. Hypertension noted with systolic blood pressure measuring above 150 mm Hg. Endoscopy showed three duodenal ulcers. Baseline investigations showed a potassium of 2.8 mmol/l with refractory to intravenous replacement. Above combined with bicarbonate was 40 mmol/ L and hyperglycemia without pre-existing Diabetes prompted endocrine investigations. Renin was 51.21 u IU/ml and Aldosterone was 106 pmol/l. Cortisol at six am came back significantly elevated at 4381 nmol/l with a repeat reading of 4068 nmol/l. ACTH levels were 480 ng/l-527ng/l. CT imaging revealed an infiltrating mass within the mediastinum involving the right main pulmonary artery, the SVC, extending to the right lung. Bilateral adrenal masses, liver lesion, ascites and multiple subcutaneous deposits were noted through the thorax and upper abdomen. Imaging of the brain showed a metastatic lesion in the left parietal lobe. Core biopsy results from cutaneous nodule, were suggestive of a high grade neuroendocrine/small cell lung carcinoma. Despite management in ICU with Metyrapone and Dexamethasone the patient deteriorated further and was deemed not fit for chemotherapy from the Respiratory MDM. Sadly, she passed away 32 days after the initial presentation, in the palliative care ward in Omagh Hospital.