Abstract
A 53-year-old woman with a history of metastatic small-cell lung cancer was evaluated during an inpatient admission for Cushing’s syndrome on the basis of new findings of hypertension, hypokalemia, hyperglycemia, and metabolic alkalosis.
A focused physical examination was performed to assess for the antianabolic effects of excess cortisol. The thickness of the skin on the back of her third finger was 1.2 mm (reference value, >1.8) when measured with skin calipers (Panels A and B). Thin skin — a clinical sign strongly suggestive of hypercortisolism — results from inhibition of collagen synthesis by glucocorticoids.
Magnetic resonance imaging of the brain showed no pituitary abnormalities. Whole-body restaging imaging showed new metastatic lesions in the lungs, bones, liver, and meninges. A diagnosis of Cushing’s syndrome — presumed to be paraneoplastic — was made.
After discussing her prognosis with her physicians, the patient opted for palliative care and died 1 week later.
Filed under: Cancer, Cushing’s, Rare Diseases, symptoms | Tagged: hypercortisolism, hyperglycemia, hypertension, hypokalemia, metabolic alkalosis, skin, small-cell lung cancer |