{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T23:59:14Z","timestamp":1783382354518,"version":"3.54.6"},"reference-count":18,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2018,7,9]]},"abstract":"<jats:p>Ectopic adrenocorticotropic hormone (ACTH) secretion represents 5%\u201310% of cases of Cushing\u2019s syndrome (CS), and approximately 50%\u201360% of these arise from neuroendocrine lung tumours, including small-cell lung cancer (SCLC). We report a 42-year-old man admitted with hypertension, metabolic alkalosis and severe hypokalaemia. On physical examination, centripetal obesity with \u2018moon face\u2019 and \u2018buffalo\u2019s hump\u2019 were identified, and wheezing on left lung was heard. A markedly elevated serum cortisol, ACTH and urine free cortisol production supported the diagnosis of CS. Chest CT showed a left hilar mass with metastasis to the liver, adrenal glands and lymph nodes. Bronchoscopy identified bronchial infiltration by SCLC. Treatment with metyrapone and chemotherapy was started. Despite initial improvement, progressive clinical deterioration occurred, culminating in death 1\u2009year after diagnosis. Ectopic ACTH secretion is uncommon but should be suspected in patients with severe hypokalaemia, hypertension and metabolic alkalosis, especially in the context of lung cancer.<\/jats:p>","DOI":"10.1136\/bcr-2017-223406","type":"journal-article","created":{"date-parts":[[2018,8,16]],"date-time":"2018-08-16T09:55:23Z","timestamp":1534413323000},"page":"bcr-2017-223406","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Hypertension and severe hypokalaemia associated with ectopic ACTH production"],"prefix":"10.1136","volume":"2018","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8365-4867","authenticated-orcid":false,"given":"Tiago","family":"Lobo Ferreira","sequence":"first","affiliation":[{"name":"Internal Medicine Department, Hospital Garcia de Orta, Almada, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiago","family":"Nunes da Silva","sequence":"additional","affiliation":[{"name":"Endocrinology Department, Hospital Garcia de Orta, Almada, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dolores","family":"Can\u00e1rio","sequence":"additional","affiliation":[{"name":"Pneumology Department, Hospital Garcia de Orta, Almada, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Francisca Delerue","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Hospital Garcia de Orta, Almada, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,8,16]]},"reference":[{"key":"2025082805105216000_2018.aug16_1.bcr-2017-223406.1","doi-asserted-by":"publisher","DOI":"10.4065\/mcp.2010.0099"},{"key":"2025082805105216000_2018.aug16_1.bcr-2017-223406.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.lungcan.2005.08.015"},{"key":"2025082805105216000_2018.aug16_1.bcr-2017-223406.3","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1590\/S0004-27302008000600019","article-title":"Severe hypertension and hypokalemia as first clinical manifestations in ectopic Cushing\u2019s syndrome","volume":"52","author":"Fern\u00e1ndez-Rodr\u00edguez","year":"2008","journal-title":"Arq Bras Endocrinol Metabol"},{"key":"2025082805105216000_2018.aug16_1.bcr-2017-223406.4","doi-asserted-by":"crossref","first-page":"e187","DOI":"10.1016\/j.jemermed.2016.12.011","article-title":"An Unlikely Cause of Hypokalemia","volume":"52","author":"Hine","year":"2017","journal-title":"J Emerg Med"},{"key":"2025082805105216000_2018.aug16_1.bcr-2017-223406.5","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1111\/1759-7714.12403","article-title":"Ectopic Cushing syndrome in small cell lung cancer: A case report and literature review","volume":"8","author":"Zhang","year":"2017","journal-title":"Thorac Cancer"},{"key":"2025082805105216000_2018.aug16_1.bcr-2017-223406.6","doi-asserted-by":"publisher","DOI":"10.1530\/eje.1.02278"},{"key":"2025082805105216000_2018.aug16_1.bcr-2017-223406.7","doi-asserted-by":"crossref","first-page":"907","DOI":"10.4158\/EP161677.OR","article-title":"ectopic cushing syndrome: a 10-year experience from a tertiary care center in southern india","volume":"23","author":"Sathyakumar","year":"2017","journal-title":"Endocr Pract"},{"key":"2025082805105216000_2018.aug16_1.bcr-2017-223406.8","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2008.427"},{"key":"2025082805105216000_2018.aug16_1.bcr-2017-223406.9","doi-asserted-by":"publisher","DOI":"10.1210\/jc.85.1.42"},{"key":"2025082805105216000_2018.aug16_1.bcr-2017-223406.10","unstructured":"Stewart PM . 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