{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:03:33Z","timestamp":1756425813052,"version":"3.44.0"},"reference-count":17,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,4,8]]},"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:p>An elderly gentleman was admitted to hospital with severe hypokalaemia of 1.75mmol\/L. A background of a recently diagnosed metastatic gastric carcinoma with a neuroendocrine component pointed towards the diagnosis of ectopic ACTH secretion causing this dangerous electrolyte imbalance. He was treated with aggressive potassium supplementation and the adrenal steroid synthesis blocker metyrapone to acutely control his Cushing\u2019s syndrome. Chemotherapy consisting of carboplatin\/etoposide combination was initiated but unfortunately the patients\u2019 health deteriorated, and he died three months after his initial diagnosis. This case highlights the accelerated presentation of hypercortisolism due to ectopic ACTH secretion. It discusses the classification of neuroendocrine tumours and their varied prognosis depending on the underlying tumour grade. It emphasises the importance of having a multidisciplinary team to be able to care for two underlying pathologies simultaneously: both the severe hypercortisolism and his metastatic gastric tumour.<\/jats:p>","DOI":"10.1136\/bcr-2020-240290","type":"journal-article","created":{"date-parts":[[2021,5,6]],"date-time":"2021-05-06T11:57:54Z","timestamp":1620302274000},"page":"e240290","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Ectopic ACTH secretion from a metastatic gastric carcinoma with neuroendocrine component"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8676-4233","authenticated-orcid":false,"given":"Annalisa","family":"Montebello","sequence":"first","affiliation":[{"name":"Department of Diabetes and Endocrinology, Mater Dei Hospital, Msida, Malta"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Darryl","family":"Portelli","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, Mater Dei Hospital, Msida, Malta"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Gruppetta","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, Mater Dei Hospital, Msida, Malta"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,5,6]]},"reference":[{"key":"2025082802192035000_14.5.e240290.1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-19-0877"},{"key":"2025082802192035000_14.5.e240290.2","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/j.mpmed.2017.05.007","article-title":"Cushing\u2019s syndrome","volume":"45","author":"Daniel","year":"2017","journal-title":"Medicine"},{"key":"2025082802192035000_14.5.e240290.3","doi-asserted-by":"publisher","DOI":"10.1590\/S0004-27302007000800007"},{"key":"2025082802192035000_14.5.e240290.4","doi-asserted-by":"publisher","DOI":"10.1159\/000443172"},{"key":"2025082802192035000_14.5.e240290.5","first-page":"140","article-title":"The ectopic adrenocorticotropic hormone syndrome in carcinoid tumors","volume":"21","author":"Fazel","year":"2008","journal-title":"Proc"},{"key":"2025082802192035000_14.5.e240290.6","doi-asserted-by":"publisher","DOI":"10.1530\/eje.1.02278"},{"key":"2025082802192035000_14.5.e240290.7","first-page":"e163","article-title":"Acth-Secreting neuroendocrine carcinoma of the cecum: case report and review of the literature","volume":"18","author":"Mokhtar","year":"2019","journal-title":"Clin Colorectal Cancer"},{"key":"2025082802192035000_14.5.e240290.8","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1111\/ajd.12195","article-title":"Generalised hyperpigmentation caused by ectopic adrenocorticotropic hormone syndrome with recurrent thymic neuroendocrine carcinoma","volume":"56","author":"Moon","year":"2015","journal-title":"Australas J Dermatol"},{"key":"2025082802192035000_14.5.e240290.9","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1962.03620140064010"},{"key":"2025082802192035000_14.5.e240290.10","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1016\/S0140-6736(64)91682-4","article-title":"Stomach cancer and adreno\u00b7 cortical hyperfunction","volume":"1","author":"Card","year":"1964","journal-title":"Lancet"},{"key":"2025082802192035000_14.5.e240290.11","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(197505)35:5<1430::AID-CNCR2820350529>3.0.CO;2-O"},{"key":"2025082802192035000_14.5.e240290.12","doi-asserted-by":"publisher","DOI":"10.1507\/endocrj.52.743"},{"key":"2025082802192035000_14.5.e240290.13","unstructured":"Endocrinology: Adult and Pediatric, 2-Volume Set - 7th Edition. Available: https:\/\/www.elsevier.com\/books\/endocrinology-adult-and-pediatric-2-volume-set\/jameson\/978-0-323-18907-1 [Accessed 31 Aug 2020]."},{"key":"2025082802192035000_14.5.e240290.14","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1159\/000475527","article-title":"Digestive system mixed Neuroendocrine-Non-Neuroendocrine neoplasms","volume":"105","author":"de Mestier","year":"2017","journal-title":"Neuroendocrinology"},{"key":"2025082802192035000_14.5.e240290.15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2017\/9871687","article-title":"A case report: gastric mixed Neuroendocrine-Nonneuroendocrine neoplasm with aggressive neuroendocrine component","volume":"2017","author":"Pham","year":"2017","journal-title":"Case Rep Pathol"},{"key":"2025082802192035000_14.5.e240290.16","doi-asserted-by":"crossref","first-page":"2802","DOI":"10.1016\/j.ejca.2014.08.004","article-title":"Prognostic significance of neuroendocrine components in gastric carcinomas","volume":"50","author":"Park","year":"2014","journal-title":"Eur J Cancer"},{"key":"2025082802192035000_14.5.e240290.17","doi-asserted-by":"crossref","first-page":"252","DOI":"10.21037\/atm.2018.06.27","article-title":"Histopathological, immunohistochemical, genetic and molecular markers of neuroendocrine neoplasms","volume":"6","author":"Kyriakopoulos","year":"2018","journal-title":"Ann Transl Med"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-240290","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T09:19:31Z","timestamp":1756372771000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-240290"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5]]},"references-count":17,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,5,6]]},"published-print":{"date-parts":[[2021,5]]}},"alternative-id":["10.1136\/bcr-2020-240290"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-240290","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2021,5]]}}}