Question

A 55-year-old travel journalist presents with a 2-day history of hemoptysis. He has had a chronic cough, which he attributed to his 40-pack-year history of cigarette smoking. He also reports that he has been bruising easily. On examination, he has moon facies and truncal obesity, with wasting of his shoulder muscles. He has several red-purple striae over his anterior abdominal wall. The lungs are clear to auscultation. Laboratory results are as follows: Hemoglobin 12g/dl, white blood cell count 8 x 103/mm3, platelets 160 x 103/mm3, sodium 138mmol/L, potassium 3.0 mmol/L. Tuberculin skin test is negative. Sputum cytology is positive for carcinoma.

What is the most likely diagnosis?

1. Lambert-Eaton myasthenic syndrome
2. Hypertrophic pulmonary osteoarthropathy
3. Horner's syndrome
4. Ectopic adrenocorticotropic hormone (ACTH) secretion
5. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Answer 1

The most likely diagnosis for the 55-year-old travel journalist is ectopic adrenocorticotropic hormone (ACTH) secretion, which is indicated by the symptoms of Cushing's syndrome and positive sputum cytology for carcinoma.

Step-by-step explanation:

The most likely diagnosis for the 55-year-old travel journalist is ectopic adrenocorticotropic hormone (ACTH) secretion.

The symptoms presented in the case, such as chronic cough, hemoptysis, bruising easily, moon facies, truncal obesity, and wasting of shoulder muscles, are indicative of Cushing's syndrome. Cushing's syndrome is characterized by excessive production of cortisol, which can be caused by ectopic ACTH secretion. The positive sputum cytology for carcinoma suggests that the ectopic ACTH secretion may be due to an underlying lung tumor.