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Ectopic ACTH syndrome: clinicopathological correlations.

W Singer, K Kovacs, N Ryan

    Journal of Clinical Pathology
    |June 1, 1978
    PubMed
    Summary
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    Ectopic ACTH syndrome occurred in 10 of 164 lung cancer cases, primarily with oat-cell carcinoma. Early diagnosis remains challenging, with only 4 of 10 patients identified before death.

    Area of Science:

    • Endocrinology
    • Oncology
    • Pathology

    Background:

    • Ectopic ACTH syndrome is a rare complication of malignancy.
    • Oat-cell carcinoma is a common cause of ectopic ACTH syndrome.

    Purpose of the Study:

    • To determine the prevalence of ectopic ACTH syndrome in bronchogenic carcinoma.
    • To investigate the pathological features and clinical presentation of ectopic ACTH syndrome.
    • To discuss strategies for earlier diagnosis.

    Main Methods:

    • Retrospective analysis of 164 necropsy cases of bronchogenic carcinoma.
    • Pathological examination including immunohistochemistry for ACTH.
    • Clinical data review for ante mortem diagnosis.

    Main Results:

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    • Ten cases (6.1%) showed pathological evidence of ectopic ACTH syndrome.
    • All cases were associated with oat-cell carcinoma (19% of oat-cell cases).
    • Pathological findings included adrenocortical hyperplasia and pituitary changes; ACTH was detected in the pituitary but not tumor tissue.
    • Ante mortem diagnosis was made in only 4 of 10 patients, often in terminal stages.

    Conclusions:

    • Ectopic ACTH syndrome is a significant, though often undiagnosed, complication of oat-cell lung cancer.
    • Clinical presentation is frequently non-specific, hindering early diagnosis.
    • Further research into diagnostic markers and clinical suspicion is warranted for timely intervention.