Paraneoplastic cushing’s syndrome: A diagnostic and therapeutic challenge: A case report and literature review

Ectopic Cushing syndrome (ECS) is difficult to diagnose and has a poor prognosis. We report a case of a 44-year-old male who was admitted for clinical suspicion of Cushing’s syndrome. The investigations confirmed the diagnosis of ECS. No tumor was detected in preliminary imaging tests. Then, the octreoscan showed a fixation in a suspect lung node in the middle lobe. The patient was treated initially with medical drugs, he underwent a right middle lobectomy, and yet histopathology did not reveal any nodule. However, the outcome was the healing of our patient. We reviewed published articles to access new diagnostic techniques or advantages in the treatment regimen and a prognosis of ECS. Keywords: ectopic cushing’s syndrome; paraneoplastic syndromes; lung cancer.

Download Full-text

ACTH-Dependent Cushing Syndrome: Clinical and Diagnostic Aspects, and Treatment Approaches for Ectopic Cushing’s Syndrome

Cushing's Syndrome ◽

10.1007/978-1-60327-449-4_14 ◽

2010 ◽

pp. 163-176

Author(s):

Krystallenia I. Alexandraki ◽

Andrea M. Isidori ◽

Ashley B. Grossman

Keyword(s):

Cushing’S Syndrome ◽

Cushing Syndrome ◽

Cushing's Syndrome ◽

Treatment Approaches ◽

Diagnostic Aspects ◽

Ectopic Cushing’S Syndrome

Download Full-text

Lung Carcinoid Tumors and Paraneoplastic Cushing's Syndrome: Diagnostic and Therapeutic Difficulties - A Case Report

Advances in Thoracic Diseases ◽

10.15342/atd.2021.420 ◽

2021 ◽

Vol 2021 ◽

Author(s):

Hela Kamoun ◽

Aymen Ayari ◽

Hadhemi Rejeb ◽

Sarra Zairi ◽

Hanene Smadhi ◽

...

Keyword(s):

Cushing’S Syndrome ◽

Cushing Syndrome ◽

Lung Nodule ◽

Cushing's Syndrome ◽

Middle Lobe ◽

Pathological Examination ◽

Acth Secretion ◽

Typical Carcinoid ◽

Ectopic Acth ◽

Ectopic Acth Secretion

Introduction. - Paraneoplastic Cushing's syndrome is a rare cause of endogenous hypercorticism. It is caused by ectopic secretion of ACTH by a non-pituitary endocrine tumor. The aetiological biological and radiological data are often inconclusive, which creates a problem of differential diagnosis with Cushing's disease. In addition, these tumors are often small and their location is extremely variable. As a result, the difficulties of localization require the use of specific imaging techniques.Observation. - We report the observation of a 44-year-old man suffering from diabetes and high blood pressure, presenting a severe and rapidly progressive Cushing syndrome, in connection with a hypercorticism caused by an ectopic ACTH secretion. The thoracic computed tomography performed within the framework of a search for a neoplastic origin objectified a 15 mm nodule isolated at the level of the middle lobe, the scintigraphy with octreotide marked with indium-111 found a significant fixation at the level of the lung nodule. The patient had a middle lobe lobectomy. The outcome was favorable with regression of Cushing's syndrome. Pathological examination was in favor of a typical carcinoid tumor, and the immunohistochemical complement showed tumor cell positivity for ACTH, CD56, chromogranin, and synaptophysin.Conclusion. - This observation illustrates the dilemma between the need to locate an ectopic ACTH secretion and the control of aggressive and threatening Cushing's syndrome. Early use of the octreotide scintigraphy should be considered if a topographic diagnosis of the causative tumor cannot be done through conventional imaging techniques.

Download Full-text