Simultaneously Presentation of Two Paraneoplastic Syndromes in a Patient with Lung Carcinoma

Introduction: Paraneoplastic syndromes are frequently found in lung cancer and they can be the first manifestation of disease. We present the case of a patient with small cell lung cancer and two simultaneously paraneoplastic syndromes. Clinical case: A 63 year old male patient presented with anorexia, confusion and vomiting. Laboratory investigations exhibited severe hyponatremia with high urinary sodium excretion in 24 h urine, normal serum creatinine and hepatic function, low uric acid, normal acid-base and potassium balance, normal thyroid and adrenal insufficiency excluded. In this context, the diagnosis of inappropriate anti-diuretic hormone secretion was confirmed. Computed tomography scan of the chest showed a left hilar mass and abdominal scan a large adrenal tumor. Histological and immunohistochemical aspects of the sample of transbronchial fine needle aspiration support the diagnosis of small-cell lung carcinomas. Hypercortisolism and lack of suppression on dexamethasone suppression tests in the context of high normal value of adrenocorticotropic hormone made a presumptive diagnosis that lung tumor was also secreting ectopic adrenocorticotropic hormone. Conclusion: Patients that presented simultaneously with two or more paraneoplastic syndromes were rare. Our patient presented with hyponatremia induced by inappropriate secretion of anti-diuretic hormone as the first sign of a lung cancer, then further investigations revealed adrenal tumor and hypercortisolemia due to ectopic adrenocorticotropic hormone.