A case report of a patient with neurological symptoms and ACTH producing tumor

Background and aims: Ectopic adrenocorticotropic hormone (ACTH) secretion typically results from an occult, slow-growing tumor. The diagnosis of these relatively small tumors can be difficult especially when it presents with neurological disorders. Methods: Somatic and neurological status, laboratory tests, computed tomography scan (CT),magnetic resonance imaging( RI). Results: We present a clinical case of a 43-year-old man with complaints of nausea,vomiting and fever,changed behavior. The patient was initially hospitalized in the department of psychiatry. Due to the suspicion of organic delusional disorder, he was admitted in the department of neurology with meningoradicular irritation syndrome, cognitive impairment,astheno-adynamic and paranoid syndrome. The patient was with severe hyponatremia (105mmol/l), increased C-reactive protein and ferritin, negative hepatitis B and C, RPR, HIV, COVID19, X-ray on thorax. Central nervous system infection was ruled out by examination of cerebrospinal fluid and performed MRI of the brain (1). Improvement of his condition was observed when steroid treatment was started. The hyponatremia was still persisting so ACTH and cortisol levels were checked and Addison disease was observed. Treatment with methylprednisolone and fludrocortisone was started. Because of the severe weight reduction a CTscan of the abdomen was performed with suspicion for hepatic secondary lesion and stomach cancer (exclude with fibrogastroscopy) (2). The patient was checked for tumor markers because hyponatremia persist. Due to high levels of carcinoembryonic antigen and neuron-specific enolase, CT of the chest was performed. It showed carcinoma of the right lung (3). The patient was diagnosed with ACTHproducing low-grade bronchial adenocarcinoma after biopsy. Conclusion: Ectopic ACTH producing tumor could be a difficult diagnosis when present with neurological symptoms. It should be considered especially in young adults with electrolyte disturbances. ll available techniques should be used to attempt a tumor localization and early treatment of these patients. (Figure Presented).