{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T13:01:22Z","timestamp":1785330082445,"version":"3.55.0"},"reference-count":19,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":209,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Oncological Medicine"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>\n                    Ectopic adrenocorticotropic hormone (ACTH) syndrome (EAS) is most often a paraneoplastic manifestation of small\u2010cell lung cancer and is rare in lung adenocarcinoma. Its features include a cushingoid appearance, skin hyperpigmentation, muscle weakness, hypertension, glucose intolerance, hypokalemia, and metabolic alkalosis resulting from nonsuppressible, ACTH\u2010driven hypercortisolism. We report a 70\u2010year\u2010old man admitted with pneumonia and diabetic ketonuria without acidosis, in whom EAS secondary to a poorly differentiated lung adenocarcinoma was diagnosed. Key biochemical findings were a markedly elevated 8\u2009a.m. plasma ACTH (149.3\u2009pg\/mL), grossly elevated serum cortisol (54.94\u2009\n                    <jats:italic>\u03bc<\/jats:italic>\n                    g\/dL) with loss of diurnal rhythm, elevated 24\u2010h urinary free cortisol, and failure of cortisol suppression after both low\u2010 and high\u2010dose dexamethasone, with a normal pituitary MRI\u2014a profile consistent with an ectopic ACTH source. What distinguishes this case is that the heralding presentation was a refractory metabolic emergency (hyperglycemia with diabetic ketonuria; HbA1c 6.3%, indicating no pre\u2010existing poorly controlled diabetes) rather than the classic cushingoid phenotype. The patient deteriorated rapidly and died on the third day after CT\u2010guided lung biopsy, before tumor\u2010directed therapy or confirmatory ACTH immunohistochemistry could be undertaken. This case highlights that EAS from lung adenocarcinoma may present primarily as a severe metabolic emergency and that early biochemical screening and control of hypercortisolism are critical.\n                  <\/jats:p>","DOI":"10.1155\/crom\/6307000","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T12:11:25Z","timestamp":1785327085000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ectopic Adrenocorticotropic Hormone Syndrome in a Patient Diagnosed With Lung Adenocarcinoma and Hospitalized Due to Diabetic Ketonuria: A Case Report"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7741-9067","authenticated-orcid":false,"given":"Murat","family":"Ay","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1853-7098","authenticated-orcid":false,"given":"Erhan","family":"Bozkurt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6005-134X","authenticated-orcid":false,"given":"Esra","family":"\u00d6zg\u00fcl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"e_1_2_16_1_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-6632.1974.tb14445.x"},{"key":"e_1_2_16_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5085(72)80050-7"},{"key":"e_1_2_16_3_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-83-4-521"},{"key":"e_1_2_16_4_2","doi-asserted-by":"publisher","DOI":"10.1136\/gut.16.6.473"},{"key":"e_1_2_16_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/0090-4295(73)90333-6"},{"key":"e_1_2_16_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/0090-4295(75)90365-9"},{"key":"e_1_2_16_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-410x.1978.tb03653.x"},{"key":"e_1_2_16_8_2","doi-asserted-by":"publisher","DOI":"10.1210\/jcem-30-5-590"},{"key":"e_1_2_16_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2019.11.052"},{"key":"e_1_2_16_10_2","doi-asserted-by":"publisher","DOI":"10.1188\/10.CJON.357-364"},{"key":"e_1_2_16_11_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.26029"},{"key":"e_1_2_16_12_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1982.00340200157030"},{"key":"e_1_2_16_13_2","doi-asserted-by":"publisher","DOI":"10.1210\/jendso\/bvaa046.916"},{"key":"e_1_2_16_14_2","doi-asserted-by":"publisher","DOI":"10.4103\/lungindia.lungindia_162_17"},{"key":"e_1_2_16_15_2","doi-asserted-by":"publisher","DOI":"10.21037\/apm-21-86"},{"key":"e_1_2_16_16_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12902-021-00755-0"},{"key":"e_1_2_16_17_2","doi-asserted-by":"publisher","DOI":"10.15605\/jafes.040.02.26"},{"key":"e_1_2_16_18_2","first-page":"201","article-title":"Ectopic Cushing\u2032s Syndrome in Light of Modern Diagnostic Techniques and Treatment Options","volume":"36","author":"Witek P.","year":"2015","journal-title":"Neuroendocrinology Letters"},{"key":"e_1_2_16_19_2","doi-asserted-by":"publisher","DOI":"10.22541\/au.176951402.22551490\/v1"}],"container-title":["Case Reports in Oncological 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