A Case of Ectopic Cushing Syndrome Caused by ACTH-Releasing Bronchial Carcinoid

Small cell lung cancer and bronchopulmonary carcinoid tumors are the most common causes of an ectopic release of adrenocorticotropic hormone (ACTH) release. In this article, a patient with Cushing syndrome caused by an ACTH-releasing bronchial carcinoid tumor is presented. A 65-year-old female patient was admitted to the emergency service with the complaints of blurred consciousness and loss of speech, and was diagnosed with hypoglycemia, hypopotassemia, hypercortisolemia, and a high ACTH level. Magnetic resonance images (MRI) of the pituitary gland and the abdomen revealed no pathology. Since the pituitary MRI was normal, and her central/peripheral ACTH gradient was less than 2 in bilateral inferior petrosal sinus sampling, it was considered to be a case of ectopic ACTH release. A thorax computed tomography (CT) revealed a 12x10 mm subpleural nodule at the right upper lobe apical segment. Pathological fludeoxyglucose involvement was not observed in PET–CT imaging. The patient underwent video-assisted thoracoscopic surgery wedge resection under general anesthesia and was diagnosed with typical bronchial carcinoid based on a histological study. She was discharged (in that condition) on the fifth postoperative day. Although the survival rate in patients with ectopic Cushing syndrome caused by carcinoid tumor has been reported to be 70%, the prognosis in patients over 60 is worse. The surgical elimination of the source is the most significant step in treatment.

ACTH Salgýlayan Bronþiyal Karsinoidin Neden Olduðu Ektopik Cushing Sendromu Olgusu

Küçük hücreli akciðer kanseri ve bronkopulmoner karsinoid tümörler ektopik ACTH salýnýmýnýn en sýk nedenidir ve oldukça nadir bir durumdur. Bu makalede ACTH salgýlayan bronþiyal karsinoid tümörünün neden olduðu ektopik Cushing sendromlu olguyu sunduk. Bilinç bulanýklýðý ve konuþamama þikayetleri acil servise baþvuran 65 yaþýnda kadýn hastada hipoglisemi, hipopotasemi, hiperkortizolemi ve ACTH yüksekliði saptandý. Hastanýn hipofiz ve batýn MR'da patoloji saptanmadý. Hastada hipofizer MR'ýn normal olmasý ve bilateral inferior petrozal sinüs örneklemesinde santral/periferik ACTH gradientinin 2'nin altýnda olmasý ektopik ACTH salýnýmýný düþündürdü. Toraks BT'de sað üst lob apikal segmentte 12x10 mm subplevral nodül izlendi, PET-BT görüntülemede patolojik FDG tutulumu izlenmedi. Hastaya genel anestezi altýnda VATS wedge rezeksiyon uygulandý ve histolojik incelemede tipik bronþial karsinoid tanýsý kondu. Hasta postoperatif 5. gününde haliyle ile taburcu edildi. Karsinoid tümöre baðlý ektopik Cushing sendromlu olgularda 5 yýllýk saðkalým %70 olarak bildirilmekle birlikte 60 yaþ üstü hastalarda prognozun daha kötü olduðu rapor edilmektedir. Cerrahi olarak kaynaðýn ortadan kaldýrabilmesi hastanýn tedavisindeki en önemli adýmdýr.