Case report: Ectopic Cushing's syndrome in a young male with hidden lung carcinoid tumor

Abstract

Introduction: Ectopic Cushing syndrome is a form of Cushing's in which a tumor outside the pituitary gland produces adrenocorticotropic hormone (ACTH). Small cell carcinoma and carcinoid of the lung comprises half of its cases. The main purpose of this study is to present a case of ectopic Cushing syndrome caused by a hidden lung carcinoid and how to manage it.

Presentation of case: Here we present a case of a 26year old young male complains of increased weight and appetite, proximal muscle weakness, easy bruising and appearing of purple striae on his abdomen, with a final diagnosis of ACTH secreting lung carcinoid.

Discussion: The diagnosis was made by non-invasive radiological procedures (CT scan and MRI) and serological tests. The management consisted of medical treatment which was not useful, then bilateral adrenalectomy to limit the patient symptoms. The ectopic spot was finally detected and excised surgically through thoracotomy. After six months of follow up there was no recurrence, signs and symptoms of Cushing syndrome begin to disappear.

Conclusion: Ectopic cushing syndrome is a complicated medical problem especially when it comes to identification of the ectopic spot. The surgical treatment could be curative when the spot is determined.

Keywords: Carcinoid tumor; Case report; Ectopic Cushing’s.

Fig. 1

CT of the chest shows 1.5 cm mass in the right middle lobe (red arrows).

Fig. 2

CT of the abdomen shows reappearance of adrenal glands in both sides(red arrows).

Fig. 3

Intraoperative pictures of the resected nodule: A: demonstrates dissection of the nodule from adjacent structures, B: The resection is complete with adequate surgical margin.