Is ectopic Cushing’s syndrome underdiagnosed in patients with small cell lung cancer?

Abstract

IntroductionEctopic Cushing’s syndrome (ECS) is an uncommon disorder. Recently, however, a larger proportion of patients with endogenous Cushing’s syndrome (CS) had ECS than has previously been reported.ObjectiveThe aim of this study was to determine whether ECS is an underdiagnosed disorder in patients with small-cell lung cancer (SCLC).Materials and methodsMedical records from consecutive patients diagnosed with SCLC at our hospital between 2013 and 2019 were reviewed (N = 213; mean age 69.5 ± 9 years; range, 36–89 years). The probability of having ECS was evaluated by review of biochemical and clinical features, including presence of recent onset diabetes mellitus, therapy resistant hypertension and/or spontaneous hypokalaemia.ResultsOf 213 identified patients with SCLC, one (0.5%) patient had confirmed ECS, two (1%) patients had probable ECS, and twenty-three (11%) patients had possibly ECS. Patients with SCLC and possibly or probable ECS exhibited a significantly shorter survival than patients only with SCLC (8 vs. 14 months, respectively).ConclusionsOur findings indicate that ECS is underdiagnosed in patients with SCLC. Given the serious consequences of untreated ECS, the low detection rate highlights the need to improve endocrine work-up of patients with SCLC who present with biochemical and clinical features associated with ECS. Prospective studies are needed to establish a reliable assessment of the incidence of ECS and to optimise early detection strategies.

Management of small cell lung cancer complicated with paraneoplastic Cushing’s syndrome: a systematic literature review

“…Throughout the entire selection process, 61 articles were retrieved, comprising 44 case reports ( 22 – 65 ), 7 case series ( 66 – 72 ), 9 retrospective studies ( 6 – 11 , 73 – 75 ), and 1 prospective study ( 76 ) published between 1985 and 2022 in English, Japanese, French, German, Spanish, and Korean. A total of 157 SCLC with PCS patients were involved in these 61 articles.…”

“…For differential diagnosis of CS, 132 SCLC patients (84.1% of all 157 patients) in 58 reports (95.1% of all 61 reports) were diagnosed with ECS. In 9 (15.5%) reports, 40 (30.3%) patients were diagnosed without strict evidence from combining imaging examinations with laboratory tests or reported with no mention of specific procedures for the diagnosis of ectopic hormone secretion ( 8 , 10 , 22 , 40 , 45 , 49 , 57 , 58 , 72 ). The patient reported by Cabral et al.…”

Association between PET–CT accumulation in the hypothalamic/pituitary regions and neuron-specific enolase/primary tumor in limited-stage small cell lung cancer: a case-controlled retrospective study

“…Small cell lung cancer has been reported to exhibit endocrine abnormalities. A study of 213 cases of small cell lung cancer found that the condition in one case was complicated and that in two cases was likely complicated with Cushing's syndrome associated with ectopic adrenocorticotropic hormone (ACTH) production (Piasecka et al 2022 ). Hypothyroidism and menstrual dysfunction associated with ectopic ACTH-producing tumors are reported to improve after drug treatment (Lin et al 2009 ).…”

Association between PET-CT accumulation in the hypothalamic /pituitary regions and neuron-specific enolase /primary tumor in limited-stage small cell lung cancer

“…Small cell lung cancer has been reported to exhibit endocrine abnormalities. It was reported that in 213 cases of small cell lung cancer, one case was complicated and two cases were likely complicated with Cushing's syndrome associated with ectopic adrenocorticotropic hormone (ACTH)-stimulating hormone [14]. It has also been reported that hypothyroidism and menstrual dysfunction associated with ectopic ACTH-producing tumors improved after drug treatment [15].…”