{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T08:04:14Z","timestamp":1761293054013,"version":"3.40.4"},"reference-count":16,"publisher":"BMJ","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ Case Reports"],"abstract":"<jats:p>A 79-year-old woman, a smoker, presented to the emergency department with a 2-week history of progressive dyspnoea and peripheral oedema, preceded by flu-like symptoms that had failed to improve despite antibiotics. Examination identified severe hypertension and signs consistent with severe fluid overload. Baseline chest X ray showed a right-sided abnormality. In the context of an extensive smoking history CT thorax was indicated which demonstrated a right-sided hilar mass and lymphadenopathy. Blood tests showed an unexplained metabolic alkalosis with partial respiratory compensation and hypokalaemia prompting endocrinological tests investigating Cushing's syndrome. Urinary cortisol was measured at 3174\u2005nmol\/L\/24\u2005h (normal&lt;560), serum adrenocorticotropic hormone (ACTH) of 215\u2005ng\/L (normal&lt;46). Pleural fluid cytology confirmed a diagnosis of small-cell lung cancer (SCLC). The patient's condition deteriorated despite intravenous diuretics and nitrates, metyrapone and non-invasive ventilation. Treatment was withdrawn 1\u2005week after admission. The clinical course in the presence of biochemical derangement and SCLC is highly suggestive of paraneoplastic ectopic ACTH secretion.<\/jats:p>","DOI":"10.1136\/bcr-2013-009974","type":"journal-article","created":{"date-parts":[[2013,8,14]],"date-time":"2013-08-14T12:29:26Z","timestamp":1376483366000},"page":"bcr2013009974","source":"Crossref","is-referenced-by-count":9,"title":["Cardio-respiratory failure secondary to ectopic Cushing's syndrome as the index presentation of small-cell lung cancer"],"prefix":"10.1136","volume":"2013","author":[{"given":"Conrad","family":"von Stempel","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clarissa","family":"Perks","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Corcoran","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamal","family":"Grayez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2013,8,14]]},"reference":[{"key":"2025042709033197000_2013.aug14_1.bcr2013009974.1","doi-asserted-by":"crossref","first-page":"1220","DOI":"10.1038\/bjc.2012.408","article-title":"et al. 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