tompat
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60 yr smoker comes with chief complains of wt loss , hemoptysis, cough and malaise. on physical examination he has hyperpigmentation of the skin. on lab investigation he has hyponatremia ,and fasting hypoglycemia.what cud the MOST COMMON of his condition
A.Lung ca with metastasis
B.small cell ca
C.carcinoma of adrenal glands
D.pituitary adenoma
E.MEN I
(excuse for any pit falls in q )
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| keepgoing
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B small cell ca
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| donmako
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ANS B Small cell c.
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| drduck
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then ehy there is hyperpigmentation?????
i agree that...its very much SCC....but hyperpigmentation.....points towards adrenals....preferably ACTH...
plz help
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| keepgoing
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drduck wrote:
then ehy there is hyperpigmentation?????
i agree that...its very much SCC....but hyperpigmentation.....points towards adrenals....preferably ACTH...
plz help
b/c small cell ca produces ACTH ectopically
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| keepgoing
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but hey dont we see hyperglysemia in this case...if small cell cracinoma??hypoglycemia leading to something hypofunction not hyperfunction...and low cortisol-->incr ACTH negative feedback)...surely do ahve ptifalls or shall go to books and review all again..
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| drhouse
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hey tom,
dint help much na,
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| tompat
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welcome,drhouse
hold on let people try on this
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| po
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can it be A?
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| jean robert
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i think that it s about an hematogenous metastasis of a lung cancer to the adrenal gland.
So, ans. A
Tell me if i m wrong.
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| silver
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B. Small cell CA, hyperpigmentation is due to acanthosis nigricans
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| mytime
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Interesting point I wud have picked B but now for this q that depends on the fact whichever tumor is most common Pr. oat cell or Metastasis? Somehow when I think that way it seem slike A. But again Metasis is usually in the periphery so hemoptysis?! I think not. Probably pr. So B. again!. Interesting?! I say not! Plz answer tompat !
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| me007
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sites of metastasis of prim lung cancer - #1 - adrenal gland, #2 - liver..
pt has hypofunction of adrenal, not excess of ACTH, so ans A is more likely
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| keepgoing
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me007 wrote:
sites of metastasis of prim lung cancer - #1 - adrenal gland, #2 - liver..
pt has hypofunction of adrenal, not excess of ACTH, so ans A is more likely
mets to adrenal will give hypo or hyper function? i think it would be hyperplasia not hypo function of adrenal..anyway if so what is cause of hypoglycemia thn??
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| keepgoing
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no doubt social history +symtoms--smoking+ hemoptysis_cough pointing more towards-->lung patho and electrolye imbalanace -->hypo function of ALDOSTERONE...agree hyperpigmentation--->could be nigrican acanthosis but from where hypoglycemia?????????
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| mytime
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MEN1 then pancreatitis, pitutary adenoma, pth hyperplasia.
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| new_n_lost
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mytime wrote:
MEN1 then pancreatitis, pitutary adenoma, pth hyperplasia.
if He CHanges the Question Fromn Hypo Natremia to HyperCalcemia or Even Hypokalemia then MEN wud fit.
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| me007
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keepgoing wrote: mets to adrenal will give hypo or hyper function? i think it would be hyperplasia not hypo function of adrenal..anyway if so what is cause of hypoglycemia thn??
there is a fasting hypoglycemia in adrenal insufficiency bcs of increased plasma ACTH.
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| tompat
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me oo7, po, jean u guys rock. ok my ans is A
Look lung ca primary site for metastasis is adrenal gland. metastasis will destroy resident tissue n establish its own lineage. ACTH---raised cause no cortisol feed back----hyperpigmentation.
no cortisol------fasting hypoglycemia!
no aldosteron cause of gland distruction-------hyponitremia.
answer was dectated by hypoglycemia during fasting which will be corrected by cortisol thru it's permissive action on glucagon and catecholamines.
it cant be small cell ca, cause that will increase both ACTH and cortisol with no hypoglycemia.(now if u wud say small cell ca metastasis to adrenal then also it wud be wise to say lung ca with metastasis to adrenal)
note here the close call bet these two.
adrenal gland ca metastasize to lung but there wont be fasting hypoglycemia, as it will retain its some of the parent tissue properties.
no MEN I cause it will present with some cns symptom and signs of abdominal tumor.
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| tompat
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i hope u wont mind the far fetched presumption of near destruction of both adrenals by metastasis and then hypoglycemia. thats why i said there cud be some pit falls in q, hope it go down well with u 
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| new_n_lost
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I disagree with Ur Reasoning For MEN 1 cos How wud miss the Hypercalemia caused by inc PTH
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| new_n_lost
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MEN 1 initial presentation is Hyper PTH and sometimes can be a Zollinger Ellison Syn.
if an Insulinoma is present then Fasting Hypoglycemia will be the first presenting Complaint.
If a Pituitary Adenoma is there then headaches and transient loss of Vision with visual field defects.
This Syndrome has a age grp of 20 yrs i.e adolescents and if penetrance is present then 35 yrs and 50yrs can be the presentation. For MLE 20yrs is the limit.
Hope this Helps.
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| tompat
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yah i agree with that
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| new_n_lost
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A Cause of Adrenal Insufficiency is Mets from Lung Although the clinical presentation will be very late but it does occur. The Question Shows an Abrupt onset of adrenal insufficiency. that was the discrepancy of the question otherwise a good question.
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| tompat
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hey i never said it was abrupt in onset, it just that we found it when he was presented. the process might have been going on for long.
thanks any ways i will be more careful next time.
good work guys.
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