CENTRAL DIABETES-INSIPIDUS AND CUSHINGS-SYNDROME DUE TO ECTOPIC ACTH PRODUCTION BY DISSEMINATED SMALL-CELL LUNG-CANCER - A CASE-REPORT

The present case report describes the rare clinical presentation of di abetes insipidus in a patient with an ectopic ACTH syndrome (morning p lasma cortisol 1.10 mu mol/l, morning plasma ACTH 322 ng/l) due to dis seminated small cell lung cancer including a metastasis in the posteri or pituitary. The patient was created by combination chemotherapy and at the same time received octreotide to control hypercortisolism and d esmopressin (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. Se veral months later tumour regrowth occurred, with recurrence of hyperc ortisolism (mean morning plasma cortisol 0.74 mu mol/l, mean morning p lasma ACTH 112 ng/l) but without diabetes insipidus. Early treatment o f hypercortisolism in patients with an ectopic ACTH syndrome and disse minated small cell lung cancer may prolong survival and improve the qu ality of life. (C) 1998 Elsevier Science B.V. All rights reserved.