Ectopic ACTH Syndrome Caused by Multifocal Pulmonary Carsinoids with 18f-FDG Uptake: Case Report

Summary In this case report, we describe the management of a patient who was admitted with an ectopic ACTH syndrome during the COVID pandemic with new-onset type 2 diabetes, neutrophilia and unexplained hypokalaemia. These three findings when combined should alert physicians to the potential presence of Cushing’s syndrome (CS). On admission, a quick diagnosis of CS was made based on clinical and biochemical features and the patient was treated urgently using high dose oral metyrapone thus allowing delays in surgery and rapidly improving the patient’s clinical condition. This resulted in the treatment of hyperglycaemia, hypokalaemia and hypertension reducing cardiovascular risk and likely risk for infection. Observing COVID-19 pandemic international guidelines to treat patients with CS has shown to be effective and offers endocrinologists an option to manage these patients adequately in difficult times. Learning points This case report highlights the importance of having a low threshold for suspicion and investigation for Cushing’s syndrome in a patient with neutrophilia and hypokalaemia, recently diagnosed with type 2 diabetes especially in someone with catabolic features of the disease irrespective of losing weight. It also supports the use of alternative methods of approaching the diagnosis and treatment of Cushing’s syndrome during a pandemic as indicated by international protocols designed specifically for managing this condition during Covid-19.

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Pulmonary nocardiosis mimicking small cell lung cancer in ectopic ACTH syndrome associated with transformation of olfactory neuroblastoma: a case report

BMC Pulmonary Medicine ◽

10.1186/s12890-018-0710-9 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 1

Author(s):

Keigo Kobayashi ◽

Takanori Asakura ◽

Makoto Ishii ◽

Soichiro Ueda ◽

Hidehiro Irie ◽

...

Keyword(s):

Lung Cancer ◽

Case Report ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Olfactory Neuroblastoma ◽

Small Cell ◽

Ectopic Acth Syndrome ◽

Small Cell Lung ◽

Ectopic Acth ◽

Pulmonary Nocardiosis

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Unusual ectopic ACTH syndrome in a patient with orbital neuroendocrine tumor, resulted false-positive outcome of BIPSS:a case report

BMC Endocrine Disorders ◽

10.1186/s12902-020-00590-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Huiwen Tan ◽

Dawei Chen ◽

Yerong Yu ◽

Kai Yu ◽

Weiming He ◽

...

Keyword(s):

Case Report ◽

Neuroendocrine Tumor ◽

False Positive ◽

Positive Outcome ◽

Ectopic Acth Syndrome ◽

Ectopic Acth

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Case Report: Incidental Finding of COVID-19 Infection after Positron Emission Tomography/CT Imaging in a Patient with a Diagnosis of Histoplasmosis and Recurring Fever

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.20-0952 ◽

2021 ◽

Author(s):

Camila Edith Stachera Stasiak ◽

David Henrique Nigri ◽

Fabrícius Rocha Cardoso ◽

Raphael Santos de Almeida Rezende d Mattos ◽

Philippe Alcântara Gonçalves Martins ◽

...

Keyword(s):

Computed Tomography ◽

Case Report ◽

Lower Lobe ◽

Cervical Region ◽

Emission Computed Tomography ◽

Fdg Uptake ◽

Emission Computed ◽

Positron Emission ◽

Positron Emission Computed Tomography ◽

18F Fdg

This is a case report of a 37-year-old woman evaluated with 18F-fludeoxyglucose (18F-FDG) positron emission computed tomography/CT with recurrent fever after treatment with itraconazole for 6 weeks for histoplasmosis. The examination demonstrated a decrease in the dimensions of the pulmonary opacities previously identified in the left lower lobe and attributed to histoplasmosis. In addition to these pulmonary opacities, increased FDG uptake was also observed in lymph nodes present in the cervical region, mediastinum, left lung hilum, and hepatic hilum. Notably, other pulmonary opacities with ground-glass pattern that were not present in the previous computed tomography were detected in the right lower lobe, with mild 18F-FDG uptake. Nasal swab performed shortly after the examination was positive for COVID-19. In this case, the 18F-FDG positron emission computed tomography/CT study demonstrated findings consistent with active COVID-19 infection coexisting with inflammatory changes associated with histoplasmosis infection.

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