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new_n_lost
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06/28/07 - 04:10 PM

#26

By Abrupt Onset i meant Ur Question Shows that he has Inc ACTH and Hyponatremia and Hypoglycemia that is the Sign of Adrenal Insufficiency. In Lung Ca Mets u will probably will have other issues such as Cushingoid Presentation or a Dilutional Hyponatremia due to Inc ACTH & ADH respectively. They come first then the Adrenal Insufficiency will come after time has passed.

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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."

drhouse
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06/28/07 - 04:17 PM

#27

hey silver and keepgoing, u can not say hyper pigmentation of a skin as acanthosis nigricans unless it is in the Axilla. it occur in adenocarcinoma of the stomach. which is not mentioned here.

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tompat
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06/28/07 - 04:19 PM

#28

why r u presuming that there will be only small cell ca and nothing else.
i mean if it is to be squamous cell ca then there wont be any raised ACTH or ADH but only PTH raised.
still this can metastasize to adrenal leading to its insufficiency.what u say?

new_n_lost
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06/28/07 - 04:46 PM

#29

Do u know that the Oat Cell has a tendency to Mets earlier then SqCell and in ur question u havent mentioned anything that Remotely Hints to Hyper PTH. When we do questions we dont assume we just go with wht we have .

Cardinal Rule of MLE DO NOT REPEAT DO NOT ASSUME ANYTHING !!! GO WITH THE QUESTION.

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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."

tompat
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06/28/07 - 05:36 PM

#30

yah thats what exactly i m saying, dont assume that every aspect of a disease will be mentioned.like saying pt has hypercalcemia in this case.
i know that oat cell ca do metastasize before its detection, but again that doesn't mean that absolutely there is no possibility of other ca to exist.it s all about either giving details to one particular disease in options or SUFFICIENTLY GIVING INFORMATION THAT RULES OUT OTHER OPTIONS!
thats why keep ur options open at the same time dont expect each and every detail!

tompat
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06/28/07 - 05:40 PM

#31

thats why i said close call

keepgoing
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06/28/07 - 08:32 PM

#32

To tompat..i agree like i said whole scenario pointing to lung patho of whether small cell or lung mets..which could be either hypoglycemia did strike me as well as in small ell there would be HYPERGLYCEMIA..but can u plzz explain how high ACTH ?if no crtisol neg feedback????????i agree its all sign of hypofunction of adrenal but can u plzz explain high ACTH,if not cortisol??? btw i thought adrenal meta are often asymtomatic....here all sign of paraneoplastic syndrome which does not mean mets to distant organ always..anyways

good question if u made urself..good try!

tompat
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06/28/07 - 09:14 PM

#33

if mets have destroyed adrenal then there is no feedback inhibition of ACTH, that was my logic.
m i missing out on anything ur saying? it's bouncer for me.
yah i made it myself, so it s not giving a clear idea i guess. thanks any ways.

keepgoing
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06/28/07 - 09:30 PM

#34

ok no problem..in my knowledge if adrenal gets distroy-->hypofunction-->indirectly-->low cortisol/no cortisol--->there negative feedback--->increase ACTH..!does anyone have to say anything???

me007
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06/28/07 - 09:38 PM

#35

keepgoing wrote:
ok no problem..in my knowledge if adrenal gets distroy-->hypofunction-->indirectly-->l ow cortisol/no cortisol--->there negative feedback--->increase ACTH..!does anyone have to say anything???

RR Goljan p 295 2004 or i guess same in 2007 in endicrine disorders - addison's

me007
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06/28/07 - 09:40 PM

#36

q describes pt with Addison's and asks what could couse it if pt is heavy smoker.

drduck
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06/28/07 - 10:17 PM

#37

this Q really deserved so much of discussion........ grin

so what is the answer???

Luckyall
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06/28/07 - 10:34 PM

#38

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

Agree with me007! One comment though... fasting hypoglyc. is due to Cortisol defic. !

keepgoing
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06/29/07 - 12:42 AM

#39

Luckyall wrote:

Agree with me007! One comment though... fasting hypoglyc. is due to Cortisol defic. !

reason for hyperpigmention thn??

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