A 74-year-old man presents to the emergency department with new symptoms of blood tinged sputum. For the past week he has noticed streaks of blood in his chronic daily sputum production. He reports no fever or chills, but has lost 10 lb in the past 6 months involuntarily. His past medical history is significant for hypertension, dyslipidemia, and a 40-pack year history of smoking.On physical examination, he has bilateral expiratory wheezes, and there is clubbing of his fingers. No lymph nodes are detected and the remaining examination is normal. A CXR reveals a left hilar mass. Which of the following suggests that the tumor is a small cell lung cancer?
Correct Answer: syndrome of inappropriate anti diuretic hormone (SIADH) secretion
Description: SIADH is more characteristic of small cell lung cancer. Paraneoplastic syndromes are classified as metabolic, neuromuscular, connective tissue, dermatologic, and vascular. Acanthosis nigricans and other cutaneous manifestations (eg, dermatomyositis) are rare (< 1%). Clubbing is common and occurs in up to 30% of non-small cell lung cancers. The various endocrine syndromes occur in 12% of cases. At times, paraneoplastic syndromes may be the presenting finding in lung cancer or be the first sign of recurrence, most occur with non-small cell lung cancer. Stevens-Johnson syndrome usually follows drug allergy and is not a paraneoplastic syndrome.
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