Acute Liver Failure Due to Severe Hepatic Metastasis of Small-cell Lung Cancer Producing Adrenocorticotropic Hormone Complicating Ectopic Cushing Syndrome

• Published in: Internal Medicine Vol. 58; no. 20; pp. 2977 - 2982
• Main Authors: Kamijo, Sonoko, Hasuike, Satoru, Nakamura, Kenichi, Takaishi, Yuuka, Yamada, Yuri, Ozono, Yoshinori, Tsuchimochi, Mai, Sueta, Mitsue, Kusumoto, Kazunori, Iwakiri, Hisayoshi, Akaki, Mayumi, Tanaka, Hiroyuki, Kataoka, Hiroaki, Shimoda, Kazuya, Nagata, Kenji
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 15.10.2019; Japan Science and Technology Agency
• Subjects: ACTH Syndrome, Ectopic - complications; ACTH-producing tumor; Adrenocorticotropic hormone; Adrenocorticotropic Hormone - biosynthesis; Aged; Case Report; Cortisol; Cushing syndrome; Cushing Syndrome - complications; Drug overdose; ectopic Cushing syndrome; Fatal Outcome; Humans; Hydrocortisone - blood; Hyperglycemia; Hyperglycemia - etiology; Hypokalemia; Hypokalemia - etiology; Internal medicine; Liver; Liver failure; Liver Failure, Acute - etiology; Liver Neoplasms - complications; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - secondary; Lung cancer; Lung carcinoma; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - pathology; Lung nodules; Male; Menopause; Metastases; Metastasis; Nervous system diseases; Phosphopyruvate hydratase; Pituitary; Plasma levels; Small cell lung carcinoma; Small Cell Lung Carcinoma - complications; Small Cell Lung Carcinoma - diagnostic imaging; Small Cell Lung Carcinoma - secondary; small-cell lung cancer; Tomography, X-Ray Computed; Ultrasonography; liver failure; ectopic Cushing syndrome; small-cell lung cancer; ACTH-producing tumor
• ISSN: 0918-2918; 1349-7235; 1349-7235
• DOI: 10.2169/internalmedicine.1976-18

A 72-year-old man was admitted to a general hospital with progressive liver dysfunction, hypokalemia, hyperglycemia, and nodules in the lung and liver and then transferred to our institution on the seventh hospital day. Plasma levels of adrenocorticotropic hormone (ACTH), cortisol, and neuron-specific enolase concentrations were extremely high. He developed acute liver failure, his consciousness and general condition deteriorated rapidly, and he died on Day 11. At the postmortem examination, he was found to have extensive metastases from small-cell lung cancer, including advanced hepatic metastases. This is the first reported case of acute liver failure caused by metastases derived from an ACTH-producing pulmonary small-cell carcinoma.