K R L Huddle

Disseminated large cell neuroendocrine carcinoma associated with ectopic adrenocorticotropic hormone secretion

Ectopic adrenocorticotropic hormone (ACTH) secretion is associated with a heterogeneous spectrum of neuroendocrine tumours (NETs) as well as non-NET tumours. Both ectopic ACTH secretion (EAS) and NETs are relatively uncommon. Large cell neuroendocrine carcinoma (LCNEC) is considered to be a poorly differentiated NET, and is very rarely associated with EAS. Only case reports of EAS associated with LCNEC have been documented. We present a case of disseminated LCNEC associated with EAS. The LCNEC was diagnosed on bone marrow trephine biopsy, and the likely but unproven primary was a NET arising from the superior mediastinum, which also caused superior vena cava (SVC) syndrome at presentation.

Management of type 2 diabetes mellitus for general practitioners

Case scenario A 55-year-old Asian man presents with a history of intense thirst, polyuria, blurring of vision and weight loss over a period of several weeks. He is obese with a waist circumference of 110 cm and a body mass index (BMI) of 32 kg/m2. His blood pressure is 170/110 mmHg. Laboratory investigations indicate the following: random blood glucose 13.6 mmol/l, haemoglobin A1c (HbA1c) 9.5%, total serum cholesterol 6.8 mmol/l, low-density lipoprotein (LDL) cholesterol 3.5 mmol/l, high-density lipoprotein (HDL) cholesterol 0.7 mmol/l, triglycerides 3.2 mmol/l, and serum creatinine normal. His urine shows glycosuria and microalbuminuria. What would be your approach to this patients management?