A Challenging Case of an Ectopic Cushing Syndrome
Bronchopulmonary carcinoids are rare pulmonary neoplasms although they account for most cases of ectopic ACTH syndromes. When feasible, the mainstay treatment is surgical resection of the tumor. We report the case of a 52-year-old woman with signs and symptoms suggestive of hypercortisolism for 12 m...
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| Format: | Article |
| Language: | English |
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Wiley
2014-01-01
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| Series: | Case Reports in Medicine |
| Online Access: | http://dx.doi.org/10.1155/2014/413136 |
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| author | Joana Menezes Nunes Elika Pinho Isabel Camões João Maciel Pedro Cabral Bastos Conceição Souto de Moura Paulo Bettencourt |
| author_facet | Joana Menezes Nunes Elika Pinho Isabel Camões João Maciel Pedro Cabral Bastos Conceição Souto de Moura Paulo Bettencourt |
| author_sort | Joana Menezes Nunes |
| collection | DOAJ |
| description | Bronchopulmonary carcinoids are rare pulmonary neoplasms although they account for most cases of ectopic ACTH syndromes. When feasible, the mainstay treatment is surgical resection of the tumor. We report the case of a 52-year-old woman with signs and symptoms suggestive of hypercortisolism for 12 months, admitted to our department because of community acquired pneumonia. Blood hormone analysis showed increased levels of ACTH and urinary free cortisol and nonsuppressibility to high- and low-dose dexamethasone tests. Pituitary MRI showed no lesion and no central-to-peripheral ACTH gradient was present in bilateral inferior petrosal sinus sampling. CRH stimulation test suggested an ectopic ACTH source. Thoracic CT scan revealed a nodular region measuring 12 mm located in the inferior lingular lobule of the left superior lung with negative uptake by 18-FDG-PET scan and negative SRS. The patient was successfully treated with an atypical lung resection and histology revealed an atypical bronchial carcinoid tumor with positive ACTH immunoreactivity. This was an interesting case because the patient was admitted due to pneumonia that may have been associated with her untreated and chronic hypercortisolism and a challenging case of ectopic ACTH syndrome due to conflicting results on the diagnostic exams. |
| format | Article |
| id | doaj-art-45da6509ef3e4bdbac739d64f8b11d20 |
| institution | Kabale University |
| issn | 1687-9627 1687-9635 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Medicine |
| spelling | doaj-art-45da6509ef3e4bdbac739d64f8b11d202025-02-03T00:59:21ZengWileyCase Reports in Medicine1687-96271687-96352014-01-01201410.1155/2014/413136413136A Challenging Case of an Ectopic Cushing SyndromeJoana Menezes Nunes0Elika Pinho1Isabel Camões2João Maciel3Pedro Cabral Bastos4Conceição Souto de Moura5Paulo Bettencourt6Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar São João, Rua Alberto Serpa No. 150/152, 4100-010 Porto, PortugalFaculty of Medicine, Porto University, Alameda Professor Hernâni Monteiro, 4200-319 Porto, PortugalFaculty of Medicine, Porto University, Alameda Professor Hernâni Monteiro, 4200-319 Porto, PortugalCardiothoracic Surgery Department, Centro Hospitalar São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, PortugalCardiothoracic Surgery Department, Centro Hospitalar São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, PortugalFaculty of Medicine, Porto University, Alameda Professor Hernâni Monteiro, 4200-319 Porto, PortugalFaculty of Medicine, Porto University, Alameda Professor Hernâni Monteiro, 4200-319 Porto, PortugalBronchopulmonary carcinoids are rare pulmonary neoplasms although they account for most cases of ectopic ACTH syndromes. When feasible, the mainstay treatment is surgical resection of the tumor. We report the case of a 52-year-old woman with signs and symptoms suggestive of hypercortisolism for 12 months, admitted to our department because of community acquired pneumonia. Blood hormone analysis showed increased levels of ACTH and urinary free cortisol and nonsuppressibility to high- and low-dose dexamethasone tests. Pituitary MRI showed no lesion and no central-to-peripheral ACTH gradient was present in bilateral inferior petrosal sinus sampling. CRH stimulation test suggested an ectopic ACTH source. Thoracic CT scan revealed a nodular region measuring 12 mm located in the inferior lingular lobule of the left superior lung with negative uptake by 18-FDG-PET scan and negative SRS. The patient was successfully treated with an atypical lung resection and histology revealed an atypical bronchial carcinoid tumor with positive ACTH immunoreactivity. This was an interesting case because the patient was admitted due to pneumonia that may have been associated with her untreated and chronic hypercortisolism and a challenging case of ectopic ACTH syndrome due to conflicting results on the diagnostic exams.http://dx.doi.org/10.1155/2014/413136 |
| spellingShingle | Joana Menezes Nunes Elika Pinho Isabel Camões João Maciel Pedro Cabral Bastos Conceição Souto de Moura Paulo Bettencourt A Challenging Case of an Ectopic Cushing Syndrome Case Reports in Medicine |
| title | A Challenging Case of an Ectopic Cushing Syndrome |
| title_full | A Challenging Case of an Ectopic Cushing Syndrome |
| title_fullStr | A Challenging Case of an Ectopic Cushing Syndrome |
| title_full_unstemmed | A Challenging Case of an Ectopic Cushing Syndrome |
| title_short | A Challenging Case of an Ectopic Cushing Syndrome |
| title_sort | challenging case of an ectopic cushing syndrome |
| url | http://dx.doi.org/10.1155/2014/413136 |
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