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Cortisol and adrenocorticotropic hormone (ACTH) were markedly raised and were not suppressed after overnight and high-dose dexamethasone tests. Typical clinical features of Cushing\u2019s syndrome were absent. She was diagnosed with ectopic ACTH syndrome secondary to small-cell oropharyngeal cancer. Metyrapone and spironolactone were commenced; however, the patient deteriorated, and a decision was made to prioritise her comfort over escalating treatment.<\/jats:p>","DOI":"10.1136\/bcr-2024-262233","type":"journal-article","created":{"date-parts":[[2025,3,19]],"date-time":"2025-03-19T16:22:17Z","timestamp":1742401337000},"page":"e262233","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Ectopic ACTH syndrome secondary to small-cell oropharyngeal cancer"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8953-2211","authenticated-orcid":false,"given":"Alfred John","family":"Balston","sequence":"first","affiliation":[{"name":"Clinical Pharmacology, Guy's and St Thomas\u2019 NHS Foundation Trust, London, UK"},{"name":"King\u2019s College London Faculty of Life Sciences and Medicine, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grace","family":"Walker","sequence":"additional","affiliation":[{"name":"Ageing and Health, Guy's and St Thomas\u2019 NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4424-7681","authenticated-orcid":false,"given":"Aaisha","family":"Saqib","sequence":"additional","affiliation":[{"name":"Guy's and St Thomas\u2019 NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Carroll","sequence":"additional","affiliation":[{"name":"Guy's and St Thomas\u2019 NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,3,19]]},"reference":[{"key":"2025082722211522000_18.3.e262233.1","doi-asserted-by":"crossref","DOI":"10.1111\/jne.13137","article-title":"Distinguishing Cushing\u2019s disease from the ectopic ACTH syndrome: Needles in a haystack or hiding in plain sight?","volume":"34","author":"Hayes","year":"2022","journal-title":"J Neuroendocrinol"},{"key":"2025082722211522000_18.3.e262233.2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1075-122X.2004.21467.x"},{"key":"2025082722211522000_18.3.e262233.3","doi-asserted-by":"crossref","first-page":"12911","DOI":"10.21037\/apm-21-656","article-title":"Small cell metastatic prostate cancer with ectopic adrenocorticotropic hormone hypersecretion: a case report","volume":"10","author":"Riaza Montes","year":"2021","journal-title":"Ann Palliat Med"},{"key":"2025082722211522000_18.3.e262233.4","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1006\/gyno.1997.4701","article-title":"Small cell carcinoma of the vagina causing Cushing\u2019s syndrome by ectopic production and secretion of ACTH: a case report","volume":"65","author":"Colleran","year":"1997","journal-title":"Gynecol Oncol"},{"key":"2025082722211522000_18.3.e262233.5","doi-asserted-by":"crossref","unstructured":"Zeng W , Khoo J . 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