A 58-year-old man with a 2-pack-per-day smoking history presents with profound muscle weakness, hypertension, and marked hypokalemia (K+ 2.8 mEq/L). His cortisol is 28 μg/dL and does not suppress with 8 mg dexamethasone overnight. ACTH is 210 pg/mL (markedly elevated). Chest X-ray shows a 3 cm central lung mass. Which of the following is the most likely diagnosis?

  1. A)Ectopic ACTH syndrome from small cell lung cancerGABARITO
  2. B)Primary hyperaldosteronism with secondary Cushing features
  3. C)Adrenocortical carcinoma
  4. D)Pituitary-dependent Cushing disease
  5. E)ACTH-secreting bronchial carcinoid tumor

Explicação

This patient has ectopic ACTH syndrome from small cell lung cancer. Key features include markedly elevated ACTH (>100 pg/mL) with severe cortisol elevation, failure to suppress with high-dose dexamethasone (loss of HPA axis feedback control), profound hypokale... Ver explicação completa e trilha adaptativa →

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