Physical Findings

Stop & Think

Lab and X-Ray

Differential Diagnosis

The Disease

Treatment

Conclusions

Quiz & Evaluation

• I'm sure you scoped this one out long ago.
• He has a small cell carcinoma of the lung.
• It's making ACTH because it's of neuroendocrine origin.
• The ACTH is driving the adrenals to a frenzy , which
• In turn is driving gluconeogensis, which
• In turn is driving his beta cells in the pancreas to a frenzy ,
• Which in turn makes his exogenous insulin requirement variable,
• Which in turn leads to periodic wide sings in his blood sugar,
• Which in turn causes him to become light headed and even have a seizure.
• A cat's cradle of a disaster .
• So what's with the aldosterone ?