Nephrogenic Diabetes Insipidus as the First Manifestation of Ectopic ACTH Syndrome in a HIV Infected Patient

  • Everlayny Fiorot Costalonga UNIVERSIDADE FEDERAL DO ESPÍRITO SANTO
  • Amanda Weberling Coelho Moreira
  • Francisca Germanya Morais Borges
  • Veronica Gabriela Guerra
  • Thais Leibel Sant’ Anna Santos
  • Leon Cleres Penido Pinheiro
  • Susan Caroline Azevedo Aredes
  • Weverton Machado Luchi

Abstract

The Ectopic Adrenocorticotrophic Hormone (ACTH) Syndrome (EAS) is a high mortality paraneoplastic syndrome, which represents 10-15% of Cushing Syndromes (CS). Around 70% of tumors are located in the chest, neck or adrenals. It frequently has atypical manifestations, leading to delay in diagnosis. Here, we report a particular case of EAS manifested predominantly by nephrogenic diabetes insipidus (NDI). A 48 years old man, HIV infected, was admitted with polyuria, polidipsia and lower limb weakness. He had hipertension, crackles in the right hemithorax and linphanedophathy. Laboratory assessments showed hyperglycemia, hypernatremia, severe hypocalemia, metabolic alkalosis and low urinary osmolarity, which persisted after water deprivation test and desmopressin administration, characterizing a NDI. Chest images showed a lung tumor, which, in conjunction with the clinical and laboratorial picture lead to the suspicion of EAS. Cortisol levels after dexametasona were 143μg/dL and serum ACTH was 630pg/mL. Pituitary was normal and adrenals showed bilateral hyperplasia. Lymph node biopsy revealed a neuroendocrine tumor with positive immunohistochemistry for ACTH. Patient died a few days later due to nosocomial pneumonia. The EAS can be associated with very high cortisol levels, which evolves rapidly, resulting in the absence of typical features of CS. The knowledge of the different clinical presentations is essential to establish prompt diagnostic and support. This syndrome has to be considered in patients with a neoplasm and diabetes insipidus, especially if accompanied by signs of excess of mineralocorticoid action. Although the ideal treatment is excision of the tumor, adrenolitic drugs may help to reduce complications and improve survival.

Published
Aug 5, 2016
How to Cite
FIOROT COSTALONGA, Everlayny et al. Nephrogenic Diabetes Insipidus as the First Manifestation of Ectopic ACTH Syndrome in a HIV Infected Patient. International Archives of Medicine, [S.l.], v. 9, aug. 2016. ISSN 1755-7682. Available at: <http://imed.pub/ojs/index.php/iam/article/view/1589>. Date accessed: 24 nov. 2017. doi: http://dx.doi.org/10.3823/2029.
Section
Internal Medicine & Hospital Medicine

Keywords

Ectopic ACTH Syndrome; Cushing Syndrome; diabetes insipidus; lung neoplasms; HIV infection