Occult ectopic adrenocorticotropic hormone secretion: diagnostic dilemma and infective consequence
نویسندگان
چکیده
A 42-year-old male presented with polyuria, polydipsia and weight loss. His initial physical exam showed a paucity of cushingoid features. Diagnostic work up was consistent with an ectopic adrenocorticotropic hormone (ACTH) secretion. Imaging studies showed a small anterior mediastinal lesion without additional metabolically active tumors. Fine needle aspiration was consistent with a thymic neuroendocrine tumor. Following radical thymectomy, plasma ACTH and cortisol levels remained elevated. Despite medical management, he died within 2 months of presentation of disseminated intracranial aspergillosis. This case underscores the diagnostic dilemma of occult ectopic ACTH-secreting tumors and the fatal consequence of opportunistic infections.
منابع مشابه
Diagnosis of an ectopic adrenocorticotropic hormone-secreting bronchial carcinoid by somatostatin receptor scintigraphy
Ectopic adrenocorticotropic hormone (ACTH) syndrome accounts for 10%–20% of the cases of ACTH-dependent Cushing’s syndrome (1). Ectopic ACTH secretion typically results from an occult, slow-growing bronchial carcinoid tumor. The diagnosis of these relatively small tumors can be difficult with conventional imaging procedures, such as computerized tomography (CT) or magnetic resonance imaging (MR...
متن کاملC-5-hydroxytryptophan positron emission tomography: two case reports
Introduction: Pulmonary carcinoids associated with ectopic adrenocorticotropic hormone secretion have a good prognosis if histological examination shows typical pulmonary carcinoid and low proliferation, whereas a poor outcome is linked to atypical pulmonary carcinoid and high proliferation. Here we describe the diagnostic challenges to find the tumor in Cushing’s syndrome secondary to ectopic ...
متن کاملFrequency of Cushing’s syndrome due to ACTH-secreting adrenal medullary lesions: a retrospective study over 10 years from a single center
Cushing's syndrome due to ectopic adrenocorticotropic hormone production from adrenal medullary lesions has occasionally been described. We retrospectively reviewed all 164 cases of Cushing's syndrome and 77 cases of pheochromocytomas during 10 years. Of all cases with Cushing's syndrome, only two cases (1.2 %) were due to ectopic adrenocorticotropic hormone production from adrenal medullary le...
متن کاملEctopic ACTH syndrome.
Ectopic adrenocorticotropic secretion (EAS) is responsible for 12-17% of cases of Cushing's syndrome (CS) and covers a range of tumours, from undetectable benign lesions to widespread metastases. The syndrome is often associated with severe hypercortisolaemia, which aggravates the underlying condition. EAS requires a complete workup that includes the establishment of endogenous CS, diagnosis of...
متن کاملAtypical or typical adrenocorticotropic hormone-producing pulmonary carcinoids and the usefulness of 11C-5-hydroxytryptophan positron emission tomography: two case reports
INTRODUCTION Pulmonary carcinoids associated with ectopic adrenocorticotropic hormone secretion have a good prognosis if histological examination shows typical pulmonary carcinoid and low proliferation, whereas a poor outcome is linked to atypical pulmonary carcinoid and high proliferation. Here we describe the diagnostic challenges to find the tumor in Cushing's syndrome secondary to ectopic a...
متن کامل