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Adenocarcinoma of the Lung Causing Ectopic Adrenocorticotropic Hormone Syndrome

Adenocarcinoma of the Lung Causing Ectopic Adrenocorticotropic Hormone Syndrome Abstract • A patient with a left lower lung mass had muscle weakness, generalized hyperpigmentation, metabolic alkalosis, and profound hypokalemia. His elevated serum cortisol, corticosterone, and adrenocorticotropic hormone (ACTH) concentrations were not suppressed after midnight dexamethasone administration. Light and electron microscopic sections of the lung mass fitted the pathological criteria for adenocarcinoma. Immunocytochemical analysis of the tumor demonstrated specific staining with antibody to β-endorphin, suggesting that the tumor cells made the common precursor molecule of ACTH, β-lipotropin, and endorphin. This is, to the best of our knowledge, only the second case report of pulmonary adenocarcinoma associated with the syndrome of ectopic ACTH. (Arch Intern Med 1982;142:1387-1389) References 1. Brown WH: A case of pleuriglandular syndrome: 'Diabetes of bearded women.' Lancet 1928;2:1022-1023.Crossref 2. Amatruda TT, Upton GV: Hyperadrenocorticalism and ACTH-releasing factor. Ann NY Acad Sci 1974;230:168-180.Crossref 3. Balsam A, Bernstein G, Goldman J, et al: Ectopic adrenocorticotropin syndrome associated with carcinoma of the colon. Gastroenterology 1972:62:636-641. 4. Marks AD, Kim YN, Kroop HS: Ectopic production of ACTH by a minor salivary gland tumor. Ann Intern Med 1975;83:521-522.Crossref 5. Spence RW, Burns-Cox CJ: ACTH-secreting 'apudoma' of gallbladder. Gut 1975;16:473-476.Crossref 6. Newmark SR, Dluhy RG, Bennett AH: Ectopic adrenocorticotropin syndrome with prostatic carcinoma. Urology 1973;2:666-668.Crossref 7. Lovern WJ, Fariss BL, Wettlaufer JN, et al: Ectopic ACTH production in disseminated prostatic adenocarcinoma. Urology 1975;5:817-820.Crossref 8. Molland EA: Prostatic adenocarcinoma with ectopic ACTH production. Br J Urol 1978;50:358.Crossref 9. Sachs BA, Becker N, Bloomberg AE, et al: 'Cure' of ectopic ACTH syndrome secondary to adenocarcinoma of the lung. J Clin Endocrinol Metab 1970;30:590-597.Crossref 10. Azzopardi JG, Williams ED: Pathology of 'nonendocrine' tumors associated with Cushing's syndrome. Cancer 1968;22:274-286.Crossref 11. Kimula Y: A histochemical and ultrastructural study of adenocarcinoma of the lung. Am J Surg Pathol 1978;2:253-264.Crossref 12. Halmi NS, Peterson ME, Colurso GJ, et al: Pituitary intermediate lobe in dog: Two cell types and high bioactive adrenocorticotropin content. Science 1981;211:72-74.Crossref 13. Imura H, Matsukura S, Yamamoto H, et al: Studies on ectopic ACTH-producing tumors: II. Clinical and biochemical features of 30 cases. Cancer 1975;35:1430-1437.Crossref 14. Schambelan M, Slaton PE Jr, Biglieri EG: Mineralocorticoid production in hyperadrenocorticism. Am J Med 1971;51:299-303.Crossref 15. Halmi NS, Krieger DT: The immunocytochemistry of ACTH-related peptides in the hypophysis , in Bhatnagar AS (ed): The Anterior Pituitary . New York, Raven Press, in press. 16. Odell WD, Wolfsen AR, Bachelot I, et al: Ectopic production of lipotropin by cancer. Am J Med 1979;66:631-638.Crossref 17. Ayvazian LF, Schneider B, Gerwirtz G, et al: Ectopic production of big ACTH in carcinoma of the lung. Am Rev Respir Dis 1975;111:279-287. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Adenocarcinoma of the Lung Causing Ectopic Adrenocorticotropic Hormone Syndrome

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Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1982.00340200157030
Publisher site
See Article on Publisher Site

Abstract

Abstract • A patient with a left lower lung mass had muscle weakness, generalized hyperpigmentation, metabolic alkalosis, and profound hypokalemia. His elevated serum cortisol, corticosterone, and adrenocorticotropic hormone (ACTH) concentrations were not suppressed after midnight dexamethasone administration. Light and electron microscopic sections of the lung mass fitted the pathological criteria for adenocarcinoma. Immunocytochemical analysis of the tumor demonstrated specific staining with antibody to β-endorphin, suggesting that the tumor cells made the common precursor molecule of ACTH, β-lipotropin, and endorphin. This is, to the best of our knowledge, only the second case report of pulmonary adenocarcinoma associated with the syndrome of ectopic ACTH. (Arch Intern Med 1982;142:1387-1389) References 1. Brown WH: A case of pleuriglandular syndrome: 'Diabetes of bearded women.' Lancet 1928;2:1022-1023.Crossref 2. Amatruda TT, Upton GV: Hyperadrenocorticalism and ACTH-releasing factor. Ann NY Acad Sci 1974;230:168-180.Crossref 3. Balsam A, Bernstein G, Goldman J, et al: Ectopic adrenocorticotropin syndrome associated with carcinoma of the colon. Gastroenterology 1972:62:636-641. 4. Marks AD, Kim YN, Kroop HS: Ectopic production of ACTH by a minor salivary gland tumor. Ann Intern Med 1975;83:521-522.Crossref 5. Spence RW, Burns-Cox CJ: ACTH-secreting 'apudoma' of gallbladder. Gut 1975;16:473-476.Crossref 6. Newmark SR, Dluhy RG, Bennett AH: Ectopic adrenocorticotropin syndrome with prostatic carcinoma. Urology 1973;2:666-668.Crossref 7. Lovern WJ, Fariss BL, Wettlaufer JN, et al: Ectopic ACTH production in disseminated prostatic adenocarcinoma. Urology 1975;5:817-820.Crossref 8. Molland EA: Prostatic adenocarcinoma with ectopic ACTH production. Br J Urol 1978;50:358.Crossref 9. Sachs BA, Becker N, Bloomberg AE, et al: 'Cure' of ectopic ACTH syndrome secondary to adenocarcinoma of the lung. J Clin Endocrinol Metab 1970;30:590-597.Crossref 10. Azzopardi JG, Williams ED: Pathology of 'nonendocrine' tumors associated with Cushing's syndrome. Cancer 1968;22:274-286.Crossref 11. Kimula Y: A histochemical and ultrastructural study of adenocarcinoma of the lung. Am J Surg Pathol 1978;2:253-264.Crossref 12. Halmi NS, Peterson ME, Colurso GJ, et al: Pituitary intermediate lobe in dog: Two cell types and high bioactive adrenocorticotropin content. Science 1981;211:72-74.Crossref 13. Imura H, Matsukura S, Yamamoto H, et al: Studies on ectopic ACTH-producing tumors: II. Clinical and biochemical features of 30 cases. Cancer 1975;35:1430-1437.Crossref 14. Schambelan M, Slaton PE Jr, Biglieri EG: Mineralocorticoid production in hyperadrenocorticism. Am J Med 1971;51:299-303.Crossref 15. Halmi NS, Krieger DT: The immunocytochemistry of ACTH-related peptides in the hypophysis , in Bhatnagar AS (ed): The Anterior Pituitary . New York, Raven Press, in press. 16. Odell WD, Wolfsen AR, Bachelot I, et al: Ectopic production of lipotropin by cancer. Am J Med 1979;66:631-638.Crossref 17. Ayvazian LF, Schneider B, Gerwirtz G, et al: Ectopic production of big ACTH in carcinoma of the lung. Am Rev Respir Dis 1975;111:279-287.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jul 1, 1982

References