Increasing Skin Pigmentation Following Severe Head Trauma: All That Glitters Is Not Gold!
KeywordsACTH, colon adenocarcinoma, ectopic corticotropin production
We report the case of a 67-year-old man who was admitted to our Intensive Care Unit because of traumatic brain injury. During his prolonged hospitalization, gradual darkening of the skin all over his body was observed. An excess corticotropin (ACTH) production syndrome was considered. The patient’s hormone study showed high levels of ACTH (978 pg/ml) with normal cortisol levels. Extensive clinical and laboratory investigations revealed adenocarcinoma of the colon, which was likely the site of the ectopic ACTH production. This is a very rare manifestation of paraneoplastic syndrome during the course of colon adenocarcinoma. The most important feature of this case report is that this rare syndrome was accidentally discovered, in a patient hospitalized for unrelated reasons, by simple clinical investigation.
Beuschlein F, Hammer GD. Ectopic pro-opiomelanocortin syndrome. Endocrinol Metab Clin North Am 2002;31:191–234.
Odell WD. Ectopic ACTH secretion. A misnomer. Endocrinol Metab Clin North Am 1991;20:371–379.
Odell WD, Appleton WS. Humoral manifestations of cancer. In: Wilson JD, Foster DW, editors. Williams textbook of endocrinology, 8th ed. Philadelphia: WB Saunders; 1992, pp. 1599–1617.
Terzolo M, Reimondo G, Ali A, Bovio S, Daffara F, Paccoti P, Angeli A. Ectopic ACTH syndrome: molecular bases and clinical heterogeneity. Ann Oncol 2001;12(Suppl 2):S83–87.
White A, Clark AJL. The cellular and molecular basis of the ectopic ACTH syndrome. Clin Endocrinol 1993;39:131–141.
Issue: Vol. 3 No. 6 (view)