03 November 2021
: Case report 
A Rapidly Progressive Case of Ectopic Adrenocorticotropic Hormone (ACTH) Syndrome
Unusual clinical course, Challenging differential diagnosis, Unusual setting of medical care
Rishi Raj
1EF*, Robb K. Taylor2E, Douglas Owen 3E
DOI: 10.12659/AJCR.934437
Am J Case Rep 2021; 22:e934437
Table 1. Laboratory on initial presentation.
| Laboratory test | Level | Reference range |
|---|---|---|
| WBCs | 7.8 k/uL | 3.7–10.3 k/uL |
| RBCs | 3.05 M/mL | 3.–5.2 M/mL |
| Hemoglobin | 9.6 g/dL | 11.2–15.7 g/dL |
| Hematocrit | 27.3% | 34–45% |
| Platelets | 98 k/mL | 155–369 k/mL |
| MCV | 89.7 fl | 78.2–101.8 fl |
| MCH | 31.5 pg | 26.4–33.3 pg |
| MCHC | 35.2 g/dL | 32.5–35.3 g/dL |
| RDW | 15.8% | 10.1–16.2% |
| Glucose | 73 mg/dL | 74–90 mg/dL |
| Sodium | 148 mmol/L | 136–145 mmol/L |
| Potassium | 2.4 mmol/L | 3.7–4.8 mmol/L |
| Bicarbonate | 32 mmol/L | 22–29 mmol/L |
| Chloride | 108 mmol/L | 97–107 mmol/L |
| Calcium | 7.0 mg/dL | 8.9–10.2 mg/dL |
| Magnesium | 1.7 mg/dL | 1.7–2.4 mg/dL |
| Phosphorus | 2.3 mg/dL | 2.5–4.9 mg/dL |
| Albumin | 2.4 g/dL | 3.3–4.6 g/dL |
| Blood urea nitrogen | 41 mg/dL | 0–30 ng/dL |
| Creatinine | 1.60 mg/dL | 0.60–1.10 mg/dL |
| Estimated GFR | 31.5 mL/min/1.73m | >60 mL/min/1.73 m |
| Aspartate transaminase | 42 U/L | 9–36 U/L |
| Alanine transaminase | 67 U/L | 8–33 U/L |
| Alkaline phosphatase | 90 U/L | 46–142 U/L |
| Total protein | 4.8 g/dL | 6.3–7.9 g/dL |
| Arterial blood gas analysis | ||
| PaCO2 | 48.9 mmHg | 35.0–45.0 mmHg |
| PaO2 | 63.1 mmHg | 85.0–100.0 mmHg |
| %SAT | 92.8% | 93.0–97.0 |
| HCO3 | 47.8 mm/L | 20.0–26.0 mm/L |
| Base excess | 26.3 mm/L | <2.0 mm/L |
| pH | 7.599 | 7.350–7.450 |
| Adrenocorticotropic hormone (ACTH) | 174, 229 and 342 pg/mL | 15–65 pg/mL |
| Urine free cortisol, 24 h | 357 ug/24 hr | 6–42 mg/24 hr |
| 8: 00 AM cortisol following 8 mg dexamethasone (4×2 mg doses) previous day | 62.99 mg/dL | |
| 8: 00 AM dexamethasone following 8 mg dexamethasone (4×2 mg doses) previous day | 4050 ng/dL | 1600–2850 ng/dL |