Difficult Diagnosis and Management of Concealed Cushing

Area of Science:

• Endocrinology
• Oncology
• Pulmonology

Background:

• Adrenocorticotropic Hormone (ACTH)-secreting tumors cause Cushing syndrome, presenting diagnostic challenges.
• Ectopic ACTH production accounts for a minority of Cushing syndrome cases.

Purpose of the Study:

• To report a case of Cushing syndrome caused by an ectopic ACTH-secreting lung carcinoid.
• To highlight the diagnostic complexities and multidisciplinary management required for such cases.

Main Methods:

• A patient with suspected Cushing syndrome underwent extensive hormonal testing and imaging, including pituitary MRI and CT chest.
• Despite initial findings suggesting a pituitary source, ectopic ACTH production was suspected.
• A lung nodule was eventually resected and pathologically confirmed as a typical lung carcinoid.

Main Results:

• The patient presented with classic signs of Cushing syndrome, including hypertension and obesity.
• Hormonal tests indicated elevated ACTH, initially pointing towards a pituitary adenoma, but further investigation revealed an ectopic source.
• Post-surgical resection of the lung carcinoid resulted in a significant drop in ACTH levels, confirming the diagnosis.

Conclusions:

• ACTH-secreting tumors, particularly ectopic ones like lung carcinoids, pose significant diagnostic and therapeutic hurdles.
• A thorough hormonal and instrumental evaluation, coupled with a multidisciplinary team approach, is crucial for effective management.