[Cushing syndrome with occult ectopic ACTH production]

Area of Science:

• Endocrinology
• Oncology
• Pulmonology

Background:

• Cushing's syndrome is a hormonal disorder caused by prolonged exposure to high cortisol levels.
• Pituitary adenomas are the most common cause of Cushing's syndrome, but ectopic ACTH production can also occur.

Observation:

• A 19-year-old patient presented with symptoms of prolonged Cushing's syndrome, initially diagnosed as pituitary Cushing's.
• Treatment for pituitary Cushing's and ketoconazole therapy were ineffective.
• Ectopic ACTH production was suspected due to persistent hypercortisolism.

Findings:

• Bilateral adrenalectomy was performed, leading to the resolution of Cushing's syndrome symptoms.
• A CT scan revealed an intrapulmonary mass one year post-adrenalectomy.
• Histological examination confirmed a bronchial carcinoid tumor producing ACTH, with no signs of metastasis.

Implications:

• This case highlights the importance of considering ectopic ACTH production in refractory Cushing's syndrome.
• Bronchial carcinoids can present as a rare cause of ACTH-dependent Cushing's syndrome.
• Early diagnosis and surgical intervention are crucial for managing ectopic ACTH-producing tumors.