The production of hormones by nonendocrine tumors with resultant clinical syndromes secondary to hormone excess is a well-recognized concomitant of neoplasia. Approximately 15 hormones have been reported to be ectopically secreted by more than 20 different tumor types. Although small cell carcinoma of the lung produces a wide variety of peptide hormones including ADH, ACTH and related fragments, calcitonin and serotonin, ectopic production of ADH and corticotropin are seen most frequently. The simultaneous presence of both syndromes has been reported in the literature only several occasians. We experienced a case of small cell carcinoma of the lung with two paraendocrine syndromes. A 53-year-old man was seen at the nephrology department of Hangyang University Hospital on Jan#. 29, 1994. His history was significant for 3 months of hunger pain, peripheral edema and muscle weakness. He had no history of previous illness except for l month duration of mild hypertension. On physical examination, 3 cm sized right supraclavicular lymph node was palpable with a blood pressure of 150/l00 mmHg. He had no truncal obesity or abnormal skin pigmentation. Initial laboratory studies showed the following values: sodium, 109 mEq/l: potassium, 3.7 mEq/l; chloride, 91 mEq/l; bicarbonate, 22.5 mEq/l; glucose, 229 mg/dl. A diagnosis of the SIADH was considered because of the hyponatremia and the euvolemic status of the patient. The serum osmolarity was 233 mosm/kg with a less-than dilute urine osmolarity of 260 mosm/kg & 24-hour urinary sodium excretion was 104 mEq/day. Results of thyroid studies were within normal limits. The biopsy of right supraclavicular lymph node revealed metastatic small cell carcinoma. A diagnosis of ectopic ACTH production was persued to explain the development of hypertension, hyperglycemia and peripheral edema. 24-hour urine for free cortisol level was 186 pg/day (normal 10~80pg/day) & an AM ACTH level (281 pg/ml, normal, 20~100 pg/ml) was high in the presence of high cortisol level (25.69 ug/dl). Results of computed tomography of the chest showed a small mass in the right lower lobe with invasion to right inferior pulmonary vein and left atrium along with metastatic lesions in the left lobe of the liver.
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