Beyond the Dual Paraneoplastic Syndromes of Small-Cell Lung Cancer with ADH and ACTH Secretion: A Case Report with Literature Review and Future Implications

Table 2

Summary of previously published case reports of SCLC with dual ectopic ADH and ACTH secretion.

Liddle et al.	SCLC with SIADH and EAS. Chronology of SIADH and EAS was not mentioned. Na was 115 mmol/l. Clinical picture of EAS, management, and life expectancy were not described [7].
O’Neal et al.	Extensive SCLC with >3 organ metastases (liver, adrenals, brain, diaphragm, and retroperitoneal and mediastinal lymph nodes) and simultaneous SIADH and EAS, presenting with uncontrolled hypertension, puffy face, and hyponatremia (Na 121–125 mmol/l). The patient had a gradual development of hypokalemic metabolic alkalosis and Cushingoid picture in 2 months and died after 5 weeks of diagnosis of dual SIADH and EAS. Management was not described [8].
Coscia et al.	Extensive SCLC (3 cm in size) with >3 organ metastasis (adrenals, pancreas, mediastinal lymph nodes, bone marrow, liver, and spleen) and simultaneous SIADH and EAS presenting with symptomatic, profound hyponatremia (Na 103 mmol/l), hypertension, hemoptysis, and weight loss of 10 pounds without typical Cushingoid picture. The patient also had few weeks of nausea, vomiting, anorexia, and diarrhea before presentation. Hyponatremia was treated with 3% saline and fluid restriction. No antisteroid agent was used for EAS. The patient died on the 24th hospital day [9].
Suzuki et al.	Extensive SCLC with >3 organ metastasis (adrenals, contralateral lung, pleurae, liver, bone marrow, pancreas, spleen, thyroid, and multiple lymph nodes) and simultaneous SIADH and EAS presenting with significant weight loss in 6 weeks, cough, dyspnea, uncontrolled hypertension, hyperglycemia, muscle weakness, hypokalemic metabolic alkalosis, and hyponatremia (Na 126 mmol/l). The patient did not have typical Cushingoid picture. Treatment of SIADH and EAS was not mentioned. The patient was treated with nimustine without success. The patient died from severe pancytopenia and GI bleeding on the 42nd hospital day [10].
Pierce et al.	Extensive SCLC (2 cm in size) with 3 organ metastases (right adrenal gland, thyroid, and pancreas) and simultaneous SIADH and EAS, presenting with hyponatremia (Na 126 mmol/l), hypokalemia, metabolic alkalosis, hyperglycemia, hypertension, and 15-pound weight loss in one month. No typical Cushingoid picture was identified. SCLC was treated with cisplatin and etoposide; SIADH was treated with fluid restriction and demeclocycline; EAS was treated with aminoglutethimide. Despite all treatments, ADH and ACTH levels remained elevated. The patient died 127 days after diagnosis [11].
Shaker et al.	Metastatic extrapulmonary small-cell carcinoma in the bone marrow presenting with renal phosphate wasting and SIADH (Na 107 mmol/l). SIADH responded to fluid restriction and demeclocycline. There was a resolution of cancer with adriamycin, cyclophosphamide, cisplatin, and etoposide 5 months after diagnosis. Eight months after diagnosis, patient presented with bone pain, adenopathy, Cushingoid picture, hypokalemia, hypertension, and recurrent SIADH. No antisteroid agent was used for EAS. The patient died 2 months after the onset of EAS and SIADH, despite chemotherapy [12].
Mayer et al.	SCLC (3.5 cm in size) with dual sequential SIADH and EAS, initially presenting with limited-stage SCLC diagnosed from SIADH workup (Na 123 mmol/l). SIADH responded to fluid restriction, and SCLC achieved a complete remission after 4 cycles of carboplatin, etoposide, and concurrent radiation therapy. EAS occurred 8 months after diagnosis, presenting with weight loss of 20 pounds in 2 weeks, hypokalemia, muscle weakness, hyperglycemia, and hypertension. The patient had metastatic disease in the liver, pericardial lymph nodes, bilateral adrenal glands, and the mesenteric fat. The patient died 2 days after diagnosis of EAS [13].
Müssig et al.	Extensive SCLC (4.9 cm × 10.6 cm in size) with 2 organ metastases (liver and brain) and simultaneous SIADH and EAS, presenting with 28-pound weight loss over 6 months, persistent hypokalemia, and hyponatremia (Na of 116 mmol/l). EAS lacked typical Cushingoid picture. SIADH was treated with fluid restriction only. No antisteroid agent was used for EAS. A nearly complete radiological remission with resolution of SIADH and EAS was achieved after the fourth cycle of carboplatin and etoposide. Life expectancy was not mentioned [14].