Sestre Milosrdnice University hospital and Institute of Clinical Medical Research
Abstract
Histologically confirmed small cell lung cancer associated with Cushing’s syndrome and elevated amylase is rarely described in the literature. We present a case of a 63-year-old patient admitted to cardiology department due to shortness of breath, exhaustion, palpitations and nausea. Elevated values of troponin and electrocardiography suggested that he could have acute coronary syndrome. According to the radiologist’s opinion, plane lung radiography was normal. Elevated level of amylase was found in both serum (3802 U/L, normal range 28-100) and urine (12012 U/L, normal range 0-450 U/L), as well as elevated sodium (156 mmol/L, normal range 137-147 mmol/L), hyperglycemia (12 mmol/L, normal range 3.8-6.1 mmol/L) and lowered serum potassium (1.7 mmol/L, normal range 3.5-5.3 mmol/L). Computerized tomography (CT) of the
abdomen revealed a tumor of the left adrenal gland and enlargement of the right adrenal gland with normal structure of the pancreas. During hospitalization, the patient had blood while coughing and
CT scan of the lungs showed a tumor 48x38x51 mm in size localized in the laterobasal segment of the left lung with mediastinal lymphadenopathy. He also had bilateral pleural effusions with signs
of pulmonary embolism, which explained elevated troponin values. Biopsy confirmed microcellular lung carcinoma and tumor cells were diffusely positive for TT F-1 and focally for CK7, expressing
markers of neuroendocrine differentiation (chromogranin +++, synaptophysin +++, NS E ++). Since neuroendocrine tumor was confirmed and the patient had low potassium and high glucose, hypercortisolism was suspected. High morning cortisol (1784 mmol/L, normal range 171-536) and unsuppressed ACTH (214 pg/L, <60), as well as a high level of chromogranin (1339 μg/L, <65) were determined. During hospital stay, the patient developed heart and respiratory failure and died in the second week of hospitalization.Histološki potvrđeni slučajevi karcinoma malih stanica udruženi s Cushingovim sindromom i povišenim vrijednostima amilaze u serumu su jako rijetko opisani u literaturi. Prikazujemo slučaj 63-godišnjeg bolesnika primljenog na odjel kardiologije zbog kratkoće daha, iscrpljenosti, lupanja srca i mučnine. Povišene vrijednosti troponina i elektrokardiogram ukazivali su na mogući akutni koronarni sindrom. Prema mišljenju radiologa i snimaka pluća radiografija je bila normalna. Povišena razina amilaze pronađena je u serumu (3802 U/L, normalni raspon 28-100 U/L) i mokraći (12012 U/L, normalni raspon 0-450 U/L), kao i povišenje natrija (156 mmol/L, normalni raspon 137-147 mmol/L), hiperglikemija (12 mmol/L, normalni raspon 3,8-6,1 mmol/L) i nizak serumski kalij (1,7 mmol/L, normalni raspon 3,5 do 5,3 mmol/L). Kompjutorizirana tomografija (CT) trbuha pokazuje tumor lijeve nadbubrežne žlijezde i proširenja desne nadbubrežne žlijezde s normalnom strukturom gušterače. Tijekom hospitalizacije bolesnik je izbacivao krv dok kašlje i CT pluća pokazuje tumorsku
masu veličine 48x38x51 mm, lokaliziranu u laterobazalnom segmentu lijevog pluća s medijastinalnom limfadenopatijom. On je također imao bilateralne pleuralne izljeve sa znakovima plućne embolije, što je bio razlog povišene vrijednosti troponina. Biopsija je potvrdila da se radi o karcinomu pluća malih stanica i tumorske stanice su bile difuzno pozitivne na TT F-1 i fokalno na CK7, izražavajući biljege neuroendokrine diferencijacije (kromogranin +++, sinaptofizin +++, NS E ++). Kako je potrvđen neuroendokrini tumor te kako je bolesnik imao nizak kalij i visoku razinu glukoze, postavljena je sumnja
na hiperkortizolizam. To je potvrdio nalaz visoke razine jutarnjeg kortizola (1,784 mmol/L, normalni raspon 171-536) i nesuprimiranog ACTH (214 pg/L, <60), kao i visoka razina kromogranina (1339 μg/L, <65). Tijekom boravka u bolnici u bolesnika se razvila srčana i respiracijska insuficijencija te je preminuo u drugom tjednu hospitalizacije
