A 54-year-old man comes to the office due to worsening fatigue, generalized weakness, and an unintentional 7-kg weight loss over the past several weeks. He has a 40-pack-year history of smoking. Blood pressure is 160/100 mm Hg. Physical examination shows darkening of the skin in sun-exposed areas, scattered ecchymoses, and mild proximal muscle weakness. Chest imaging reveals a 6-cm, irregular right lung mass with mediastinal lymphadenopathy. Which of the following is most likely responsible for the patient's current symptoms?
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