Paper Title
Ectopic ACTH Syndrome (EAS): An Unusual case of Confusion associated with Electrolyte Abnormality and Cachexia in a new Presentation of Small Cell Lung Cancer

Abstract
A 71 year old lady presented with confusion following head injury two weeks prior. CT head was normal but MRI head showed scattered microbleeds, suspicious of axonal brain injury related to the head trauma. Blood testsrevealed hypokalaemia, deranged LFTs and severe metabolic alkalosis, raising the possibility of ectopic ACTH secretion. Further investigations confirmed very high random cortisol and ACTH levels. CT TAP was in keeping with liver metastases from a primary lung cancer, and the history of recent head injury was deemed to be non-significant. The patient remained confused and could not consent for liver biopsy or chemotherapy. DNACPR discussion took place with the family and she passed away in hospital with core drugs prescribed. This case represents an atypical presentation of SCLC, one where an endocrine cause of confusion was discovered despite a history of head injury directing us initially toward a traumatic origin of her presenting complaint.