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[Ectopic ACTH syndrome caused by bronchial carcinoid].
Zhonghua Nei Ke Za Zhi
|November 1, 1989
Summary
A patient with severe hypercorticism was initially suspected to have pituitary Cushing's syndrome. However, a bronchial carcinoid tumor producing ACTH was ultimately diagnosed, leading to remission after surgical removal and radiotherapy.
Area of Science:
- Endocrinology
- Oncology
- Pathology
Background:
- Cushing's syndrome presents with severe hypercorticism, often initially suspected to be of pituitary origin.
- Pituitary adenomas are the most common cause of Cushing's disease, but ectopic hormone production can mimic these symptoms.
Observation:
- A 35-year-old male presented with clinical and biochemical signs of severe hypercorticism.
- Initial treatment for a presumed pituitary adenoma via transsphenoidal microsurgery failed to resolve symptoms.
- A subsequent chest CT revealed a right upper-lobe lung mass, diagnosed as bronchial carcinoid.
Findings:
- The bronchial carcinoid tumor was surgically removed, and the patient received radiotherapy.
- Pathological examination confirmed bronchial carcinoid with lymph node metastasis.
- Tumor cells were found to contain adrenocorticotropic hormone (ACTH) and related peptides, with gel filtration revealing molecular heterogeneity and a high percentage of the big-form ACTH.
Implications:
- This case highlights bronchial carcinoid as a potential cause of ectopic ACTH syndrome, mimicking pituitary Cushing's disease.
- Accurate diagnosis and treatment of ectopic ACTH-producing tumors are crucial for patient remission.
- Understanding the molecular heterogeneity of ACTH peptides in tumors can offer insights into disease pathogenesis.