Tabata M, Ohnoshi T, Ueoka H, Kiura K, Segawa Y, Shibayama T, Maeda T, Miyatake K, Takigawa N, Kimura I
Second Department of Internal Medicine, Okayama University Medical School, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1993 Feb;31(2):235-9.
A 62-year-old male with small cell lung cancer (SCLC) associated with Cushing's syndrome and diabetes insipidus (DI) is reported. The patient was referred to our hospital for treatment of SCLC. A diagnosis of paraneoplastic Cushing's syndrome was made on the basis of an elevated serum ACTH (623.5 pg/ml) level, elevated excretion of urinary 17-OHCS (18.01 mg/day), obesity, hypertension, hyperglycemia, persistent hypokalemia, alkalosis, and no history of diabetes mellitus. He was also diagnosed as having DI based on polyuria and polydipsia, low specific gravity of the urine (1.007-1.010), low serum ADH (1.4 pg/ml) level, normal plasma osmolarity (29 mOsm/kg H2O), and the results of water deprivation test. DI and a left visual field defect was suggestive of metastasis to the pituitary region, but no lesion was detected by either CT scan or MRI scan. The patient failed to show a good response to intensive chemotherapy, and died of the tumor five months after commencing chemotherapy. Post-mortem examination revealed metastases to the hypothalamic-neurohypophyseal region, lungs, liver, adrenal glands, bone, bone marrow, and hilar and mediastinal lymph nodes.
报告了一名62岁男性，患有小细胞肺癌（SCLC），并伴有库欣综合征和尿崩症（DI）。该患者因小细胞肺癌被转诊至我院治疗。基于血清促肾上腺皮质激素（ACTH）水平升高（623.5 pg/ml）、尿17-羟皮质类固醇排泄量增加（18.01 mg/天）、肥胖、高血压、高血糖、持续性低钾血症、碱中毒以及无糖尿病病史，诊断为副肿瘤性库欣综合征。基于多尿、烦渴、低尿比重（1.007 - 1.010）、低血清抗利尿激素（ADH）水平（1.4 pg/ml）、正常血浆渗透压（29 mOsm/kg H₂O）以及禁水试验结果，他还被诊断为尿崩症。尿崩症和左侧视野缺损提示垂体区域转移，但CT扫描和MRI扫描均未发现病变。该患者对强化化疗反应不佳，化疗开始五个月后死于肿瘤。尸检发现肿瘤转移至下丘脑 - 神经垂体区域、肺、肝、肾上腺、骨、骨髓以及肺门和纵隔淋巴结。
