Is ectopic Cushing's syndrome underdiagnosed in patients with small cell lung cancer?

Marta Piasecka; Martin Larsson; Eleni Papakokkinou; Lena Olsson; Oskar Ragnarsson

doi:10.3389/fmed.2022.954033

Is ectopic Cushing's syndrome underdiagnosed in patients with small cell lung cancer?

Front Med (Lausanne). 2022 Aug 30:9:954033. doi: 10.3389/fmed.2022.954033. eCollection 2022.

Authors

Marta Piasecka^{1

2}, Martin Larsson³, Eleni Papakokkinou^{1

2}, Lena Olsson³, Oskar Ragnarsson^{1

2}

Affiliations

¹ Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
² Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden.
³ Department of Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.

Abstract

Introduction: Ectopic Cushing's syndrome (ECS) is an uncommon disorder. Recently, however, a larger proportion of patients with endogenous Cushing's syndrome (CS) had ECS than has previously been reported.

Objective: The aim of this study was to determine whether ECS is an underdiagnosed disorder in patients with small-cell lung cancer (SCLC).

Materials and methods: Medical records from consecutive patients diagnosed with SCLC at our hospital between 2013 and 2019 were reviewed (N = 213; mean age 69.5 ± 9 years; range, 36-89 years). The probability of having ECS was evaluated by review of biochemical and clinical features, including presence of recent onset diabetes mellitus, therapy resistant hypertension and/or spontaneous hypokalaemia.

Results: Of 213 identified patients with SCLC, one (0.5%) patient had confirmed ECS, two (1%) patients had probable ECS, and twenty-three (11%) patients had possibly ECS. Patients with SCLC and possibly or probable ECS exhibited a significantly shorter survival than patients only with SCLC (8 vs. 14 months, respectively).

Conclusions: Our findings indicate that ECS is underdiagnosed in patients with SCLC. Given the serious consequences of untreated ECS, the low detection rate highlights the need to improve endocrine work-up of patients with SCLC who present with biochemical and clinical features associated with ECS. Prospective studies are needed to establish a reliable assessment of the incidence of ECS and to optimise early detection strategies.

Keywords: ectopic ACTH-production; ectopic Cushing’s syndrome; hypercortisolism; paraneoplastic syndrome; small-cell lung cancer (SCLC).