ECTOPIC ACTH SECRETION WITH CONCOMITANT HYPERAMYLASEMIA IN A PATIENT WITH SMALL CELL LUNG CARCINOMA: CASE REPORT.

Histologically confirmed small cell lung cancer associated with Cushing's syndrome and elevated amylase is rarely described in the literature. We present a case of a 63-year-old patient admitted to cardiology department due to shortness of breath, exhaustion, palpitations and nausea. Elevated values of troponin and electrocardiography suggested that he could have acute coronary syndrome. According to the radiologist's opinion, plane lung radiography was normal. Elevated level of amylase was found in both serum (3802 U/L, normal range 28-100) and urine (12012 U/L, normal range 0-450 U/L), as well as elevated sodium (156 mmol/L, normal range 137-147 mmol/L), hyperglycemia (12 mmol/L, normal range 3.8-6.1 mmol/L) and lowered serum potassium (1.7 mmol/L, normal range 3.5-5.3 mmol/L). Computerized tomography (CT) of the abdomen revealed a tumor of the left adrenal gland and enlargement of the right adrenal gland with normal structure of the pancreas. During hospitalization, the patient had blood while coughing and CT scan of the lungs showed a tumor 48x38x51 mm in size localized in the laterobasal segment of the left lung with mediastinal lymphadenopathy. He also had bilateral pleural effusions with signs of pulmonary embolism, which explained elevated troponin values. Biopsy confirmed microcellular lung carcinoma and tumor cells were diffusely positive for TTF-1 and focally for CK7, expressing markers of neuroendocrine differentiation (chromogranin +++, synaptophysin +++, NSE ++). Since neuroendocrine tumor was confirmed and the patient had low potassium and high glucose, hypercortisolism was suspected. High morning cortisol (1784 mmol/L, normal range 171-536) and unsuppressed ACTH (214 pg/L, < 60), as well as a high level of chromogranin (1339 µg/L, < 65) were determined. During hospital stay, the patient developed heart and respiratory failure and died in the second week of hospitalization.

The analysis of factors associated with improved glycemic control in patients with insulin-requiring type 2 diabetes mellitus after treatment.

AIM: To observe the effect of standardized ten-day diabetes prevention and control program on glycemic control, and to analyze factors contributing significantly to improvement of glycemic control after the program/intervention. METHODS: A cross-sectional nested case-control study on 91 adult patients with insulin-requiring type 2 diabetes mellitus who underwent a standardized ten-day diabetes program in the Specialized Hospital "Merkur" in Vrnjacka Banja, Serbia, from June the 1st to August 1st 2010 was performed. All necessary data were obtained from patients' medical files archived in this institution. Cases (n=32) and controls (n=32) were matched for age and sex. RESULTS: Diabetes program led to a significant decrease in mean daily blood glucose (p=0.039), achieved at the expense of the reduction of postprandial hyperglycemia (p=0.013). Male patients, patients with mean daily glycemia above the acceptable range before the intervention, and patients who were receiving combined therapy (insulin plus oral antidiabetics) before the intervention, were significantly more likely to achieve such positive outcome (ORadjusted = 344.48, 12.83, and 25.44 respectively, with 95%CIs that not included 1). CONCLUSION: Standardized ten-day diabetes educational and rehabilitation program in the Specialized Hospital "Merkur" could be efficient in improving glycemic control, especially for male patients whose glucoregulation was poor despite the combined therapy with insulin and oral antidiabetic agents. Further investigation on determinants of efficiency of this program are necessary to understand better how to facilitate and support improvements in diabetes control at the population level.