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Clinical Trial
. 2011 Oct 1;117(19):4381-9.
doi: 10.1002/cncr.26029. Epub 2011 Mar 15.

Cushing syndrome secondary to ectopic adrenocorticotropic hormone secretion: the University of Texas MD Anderson Cancer Center Experience

Shamim Ejaz  1 , Rena Vassilopoulou-Sellin, Naifa L Busaidy, Mimi I Hu, Steven G Waguespack, Camilo Jimenez, Anita K Ying, Maria Cabanillas, Maher Abbara, Mouhammed Amir Habra
Affiliations
Clinical Trial

Cushing syndrome secondary to ectopic adrenocorticotropic hormone secretion: the University of Texas MD Anderson Cancer Center Experience

Shamim Ejaz et al. Cancer. .

Abstract

Background: Cushing syndrome (CS) secondary to ectopic adrenocorticotropic hormone (ACTH) secretion (EAS) has been described in association with a variety of tumors. The current experience with this syndrome was based on a few case series and individual case reports. Limited data were available about the tumors associated with CS-EAS in a cancer center setting. In this report, the authors have described their experience with CS-EAS at The University of Texas MD Anderson Cancer Center to further enhance the current understanding and management of this syndrome.

Methods: This was a retrospective review of 43 patients with CS-EAS who were diagnosed between 1979 and 2009 at The University of Texas MD Anderson Cancer Center.

Results: Different neuroendocrine tumors were associated with CS-EAS. Twenty-one patients (48.9%) had tumors located in the chest cavity, with bronchial carcinoid and small cell lung cancer representing the 2 most common causes. The ACTH source remained occult in 4 patients (9.3%) despite extensive workup. Clinical presentation varied, and the classic features of CS were not evident in some patients. Death occurred in 27 patients (62.8%), and the median overall survival was 32.2 months. Major morbidities included new-onset or worsening hyperglycemia (77%), symptomatic venous thromboembolism (14%), and infections (23%).

Conclusions: In patients with CS-EAS who attended a comprehensive cancer center, tumors originating in the chest cavity were the leading tumors associated with this syndrome. The authors suspect that CS-EAS is under reported because of the atypical presentation in some patients. Thus, they suggest careful evaluation of patients with neuroendocrine tumors to avoid missing coexisting CS-EAS.

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Figures

Figure. 1
Figure. 1
The Kaplan-Meier curve for overall survival in this series (n=43). Median OS was 32.2 months.
Figure. 2
Figure. 2. Suggested algorithm for diagnostic work-up for ACTH-Dependent Cushing's Syndrome
IPSS: Inferior Petrosal Sinus Sampling
See this image and copyright information in PMC

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