Ectopic ACTH-producing large cell neuroendocrine Pancoast tumour presenting as Horner syndrome.
We present an interesting case where a patient is presented with a droopy left eyelid (as part of Horner syndrome) and Cushingoid features which were a result of a Pancoast tumour (apical lung tumour in superior pulmonary sulcus) involving the left lung. This tumour was secreting ectopic adrenocorticotropic hormone (ACTH), a paraneoplastic endocrine phenomenon, which resulted in Cushing syndrome symptomatology. Though most ectopic ACTH-producing lung cancers are either small cell or carcinoid tumours, this was in fact a large cell neuroendocrine cancer (LCNEC). Patient underwent surgical resection and adjuvant/neoadjuvant chemotherapy with radiation; however, he succumbed to LCNEC given aggressive nature of the disease.
Hospitalist, Department of Hospital Medicine, Augusta Health, Fishersville, Virginia, USA.
Rajanshu
R
Verma
Edward Via College of Osteopathic Medicine, Blacksburg, Virginia, USA.
Alexandra
A
Lambert
Department of Endocrinology, Allina Health United Medical Specialties Clinic, St. Paul, Minnesota, USA.
Harold H
HH
Katz
Department of Family Medicine, Apple Valley Medical Clinic, Apple Valley, Minnesota, USA.
Scott J
SJ
Benson
D000182:ACTH Syndrome, Ectopic / Q000175:diagnosis* / Q000209:etiology; D000324:Adrenocorticotropic Hormone; D002276:Carcinoid Tumor / Q000150:complications / Q000378:metabolism / Q000601:surgery; D018287:Carcinoma, Large Cell / Q000150:complications* / Q000378:metabolism; D005221:Fatigue / Q000209:etiology; D006732:Horner Syndrome; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000378:metabolism; D008297:Male; D020360:Neoadjuvant Therapy; D010178:Pancoast Syndrome
D000324:Adrenocorticotropic Hormone