Castro Cabezas M, Vrinten D H, Burgers J A, Croughs R J
Department of Internal Medicine and Endocrinology, University Hospital, Utrecht, Netherlands.
Neth J Med. 1998 Jul;53(1):32-6. doi: 10.1016/s0300-2977(98)00051-5.
The present case report describes the rare clinical presentation of diabetes insipidus in a patient with an ectopic ACTH syndrome (morning plasma cortisol 1.10 mumol/l, morning plasma ACTH 322 ng/l) due to disseminated small cell lung cancer including a metastasis in the posterior pituitary. The patient was treated by combination chemotherapy and at the same time received octreotide to control hypercortisolism and desmopressin (DDAVP) to control polyuria. Partial tumour remission was achieved resulting in decreased cortisol production and disappearance of the diabetes insipidus. Medical treatment could be discontinued. Several months later tumour regrowth occurred, with recurrence of hypercortisolism (mean morning plasma cortisol 0.74 mumol/l, mean morning plasma ACTH 112 ng/l) but without diabetes insipidus. Early treatment of hypercortisolism in patients with an ectopic ACTH syndrome and disseminated small cell lung cancer may prolong survival and improve the quality of life.
本病例报告描述了一名因播散性小细胞肺癌导致异位ACTH综合征（晨血浆皮质醇1.10μmol/L，晨血浆ACTH 322ng/L）的患者出现尿崩症的罕见临床表现，该癌症包括垂体后叶转移。患者接受了联合化疗，同时接受奥曲肽以控制高皮质醇血症和去氨加压素（DDAVP）以控制多尿。实现了部分肿瘤缓解，导致皮质醇产生减少和尿崩症消失。药物治疗可以停止。几个月后肿瘤复发，高皮质醇血症复发（平均晨血浆皮质醇0.74μmol/L，平均晨血浆ACTH 112ng/L），但无尿崩症。对异位ACTH综合征和播散性小细胞肺癌患者的高皮质醇血症进行早期治疗可能会延长生存期并改善生活质量。
