THYMIC CARCINOID WITH ADRENOCORTICOTROPIC HORMONE-PRODUCING ECTOPIC CUSHING SYNDROME AND EMPTY SELLA

Area of Science:

• Endocrinology
• Oncology
• Thoracic Surgery

Background:

• Ectopic Cushing's syndrome is a rare condition often caused by neuroendocrine tumors.
• Thymic carcinoids are infrequent sources of ectopic adrenocorticotropic hormone (ACTH) production.
• Diagnosis and management can be challenging due to the rarity and potential complexity of the condition.

Purpose of the Study:

• To present a case of severe ectopic Cushing's syndrome secondary to a large ACTH-producing thymic carcinoid.
• To highlight the diagnostic and management challenges associated with this rare presentation.
• To discuss the clinical features and endocrine findings in a patient with a thymic carcinoid and ectopic ACTH secretion.

Main Methods:

• Case report of a 43-year-old female with a history of primary hyperaldosteronism.
• Clinical presentation included acute onset of Cushingoid symptoms and severe hypokalemia.
• Diagnostic workup involved biochemical tests (urine cortisol, ACTH) and imaging (CT, MRI).
• Surgical resection of the mediastinal mass via video-assisted thoracoscopic surgery (VATS).

Main Results:

• The patient presented with symptoms of severe hypercortisolism and hypokalemia.
• Elevated ACTH and urine cortisol levels confirmed ectopic Cushing's syndrome.
• Imaging revealed a large mediastinal mass consistent with thymic carcinoid.
• Post-operative pathology confirmed a well-differentiated thymic carcinoid with ACTH staining.
• Surgical resection led to complete resolution of symptoms and normalization of hormone levels.

Conclusions:

• Thymic carcinoid is a rare but significant cause of ectopic ACTH syndrome.
• Multidisciplinary approach is crucial for diagnosis and management.
• Surgical resection is the definitive treatment for curative intent.
• This case underscores the importance of considering rare endocrine etiologies in complex presentations.