A 74yo smoker presented to his GP with cough and SOB. Exam revealed pigmentation of the oral mucosa and also over the palms and soles. Tests show that he is diabetic and hypokalemic. What is the most probable dx?
a. Pseudocushing syndrome
b. Conns disease
c. Ectopic ACTH
d. Cushings disease
e. Hypothyroidism
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answer: C
why?
1) ectopic ACTH-secreting tumor can be (e.g. small cell lung carcinoma, bronchial, carcinoid, pancreatic islet cell, pheochromocytoma, or medullary thyroid tumors)........this is a smoker, old age, so likely to have lung cancer 2) Cortisol can also exhibit mineralocorticoid activity in high concentrations, leading to HYPOkalemia (common in ectopic ACTH secretion) + cortisol excess = glucose intolerance and can cause hyper-pigmentation 3) no history of steriod intake for it be pseudocushings
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