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Guendouz FE, Derrou S, Atoini F, Ouleghzal H, Safi S. Cushing´s syndrome: high aggressiveness of low-grade tumors. Pan Afr Med J 2020; 36:315. [PMID: 33193969 PMCID: PMC7603813 DOI: 10.11604/pamj.2020.36.315.23901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 07/02/2020] [Indexed: 11/24/2022] Open
Abstract
Cushing´s syndrome is caused by prolonged exposition supraphysiological to endogenous or exogenous cortisol. Ectopic production of adrenocorticotropic hormone by lung carcinoid tumors is relatively rare. Most documented cases have been reported individually. This rare neoplasm low grade that may secrete adrenocorticotropin (ACTH) leading to rapid development of hypercortisolism which is the main mode of discovery, can be a real aggressive form. This report shows a high aggressiveness of this endocrine neoplasia, wich was marked on the general, morphological, bone and psychiatric level. The trivialization of clinical signs had caused the delay in diagnosis with irreparable bone consequences.
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Affiliation(s)
- Faycal El Guendouz
- Department of endocrinology, Moulay Ismail Military Hospital of Meknes, Meknes, Morocco.,Sidi Mohamed Ben Abdellah University Fez, Fez Morocco
| | - Sara Derrou
- Department of endocrinology, Moulay Ismail Military Hospital of Meknes, Meknes, Morocco.,Sidi Mohamed Ben Abdellah University Fez, Fez Morocco
| | - Fouad Atoini
- Sidi Mohamed Ben Abdellah University Fez, Fez Morocco.,Department of thoracic surgery, Moulay Ismail Military Hospital of Meknes, Meknes, Morocco
| | - Hassan Ouleghzal
- Department of endocrinology, Moulay Ismail Military Hospital of Meknes, Meknes, Morocco.,Sidi Mohamed Ben Abdellah University Fez, Fez Morocco
| | - Somaya Safi
- Department of endocrinology, Moulay Ismail Military Hospital of Meknes, Meknes, Morocco.,Sidi Mohamed Ben Abdellah University Fez, Fez Morocco
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2
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Mehta R, Lam-Chung CE, Hinojosa-Amaya JM, Roldán-Sarmiento P, Guillen-Placencia MF, Villanueva-Rodriguez G, Juarez-Leon OA, Leon-Domínguez J, Grajales-Gómez M, Ventura-Gallegos JL, León-Suárez A, Gómez-Pérez FJ, Cuevas-Ramos D. High Molecular Weight ACTH-Precursor Presence in a Metastatic Pancreatic Neuroendocrine Tumor Causing Severe Ectopic Cushing's Syndrome: A Case Report. Front Endocrinol (Lausanne) 2020; 11:557. [PMID: 32903471 PMCID: PMC7438413 DOI: 10.3389/fendo.2020.00557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/07/2020] [Indexed: 12/17/2022] Open
Abstract
Ectopic ACTH-secretion causing Cushing's syndrome is unusual and its diagnosis is frequently challenging. The presence of high-molecular-weight precursors throughout pro-opiomelanocortin (POMC) translation by these tumors is often not reported. We present the case of a 49-year-old woman with a 3-month history of proximal muscular weakness, skin pigmentation, and weight loss. Upon initial evaluation, she had a full moon face, hirsutism, and a buffalo hump. Laboratory workup showed hyperglycemia, hypokalemia and metabolic alkalosis. ACTH, plasma cortisol, and urinary free cortisol levels were quite elevated. Serum cortisol levels were not suppressed on dexamethasone suppression testing. An octreo-SPECT scan showed enhanced nucleotide uptake in the liver and pancreas. Transendoscopic ultrasound-guided biopsy confirmed the diagnosis of a pancreatic ACTH-secreting neuroendocrine tumor (NET). Surgical excision of both pancreatic and liver lesions was carried out. Western blot analysis of the tumor and metastases revealed the presence of a high-molecular-weight precursor possibly POMC (at 30 kDa) but not ACTH (normally 4.5 kDa). ACTH-precursor secretion is more frequent in ectopic ACTH-secreting tumors compared with other causes of Cushing's syndrome. Hence, the measurement of such ACTH precursors warrants further evaluation, especially in the context of ACTH-dependent hypercortisolism.
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Affiliation(s)
- Roopa Mehta
- Neuroendocrinology Clinic, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - César Ernesto Lam-Chung
- Neuroendocrinology Clinic, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - José Miguel Hinojosa-Amaya
- Pituitary Clinic, Endocrinology Division, Department of Medicine, Hospital Universitario “Dr. José E. González” UANL. Francisco I. Monterrey, Monterrey, Mexico
| | - Paola Roldán-Sarmiento
- Neuroendocrinology Clinic, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Maria Fernanda Guillen-Placencia
- Neuroendocrinology Clinic, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Gerladine Villanueva-Rodriguez
- Neuroendocrinology Clinic, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Oscar Alfredo Juarez-Leon
- Neuroendocrinology Clinic, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Jefsi Leon-Domínguez
- Neuroendocrinology Clinic, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Mariana Grajales-Gómez
- Neuroendocrinology Clinic, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Jose Luis Ventura-Gallegos
- Biochemistry Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Andrés León-Suárez
- Neuroendocrinology Clinic, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Francisco J. Gómez-Pérez
- Neuroendocrinology Clinic, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Daniel Cuevas-Ramos
- Neuroendocrinology Clinic, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- *Correspondence: Daniel Cuevas-Ramos
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Richa CG, Saad KJ, Halabi GH, Gharios EM, Nasr FL, Merheb MT. Case-series of paraneoplastic Cushing syndrome in small-cell lung cancer. Endocrinol Diabetes Metab Case Rep 2018. [PMID: 29535866 PMCID: PMC5843798 DOI: 10.1530/edm-18-0004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The objective of this study is to report three cases of paraneoplastic or ectopic Cushing syndrome, which is a rare phenomenon of the adrenocorticotropic hormone (ACTH)-dependent Cushing syndrome. Three cases are reported in respect of clinical presentation, diagnosis and treatment in addition to relevant literature review. The results showed that ectopic ACTH secretion can be associated with different types of neoplasm most common of which are bronchial carcinoid tumors, which are slow-growing, well-differentiated neoplasms with a favorable prognosis and small-cell lung cancer, which are poorly differentiated tumors with a poor outcome. The latter is present in two out of three cases and in the remaining one, primary tumor could not be localized, representing a small fraction of patients with paraneoplastic Cushing. Diagnosis is established in the setting of high clinical suspicion by documenting an elevated cortisol level, ACTH and doing dexamethasone suppression test. Treatment options include management of the primary tumor by surgery and chemotherapy and treating Cushing syndrome. Prognosis is poor in SCLC. We concluded that in front of a high clinical suspicion, ectopic Cushing syndrome diagnosis should be considered, and identification of the primary tumor is essential.
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Affiliation(s)
- Carine Ghassan Richa
- Department of Endocrinology, Mount Lebanon Hospital, Beirut, Lebanon.,Lebanese University, Hadath, Lebanon
| | - Khadija Jamal Saad
- Department of Endocrinology, Mount Lebanon Hospital, Beirut, Lebanon.,Lebanese University, Hadath, Lebanon
| | - Georges Habib Halabi
- Department of Endocrinology, Mount Lebanon Hospital, Beirut, Lebanon.,Mount Lebanon Hospital, Beirut, Lebanon
| | - Elie Mekhael Gharios
- Department of Endocrinology, Mount Lebanon Hospital, Beirut, Lebanon.,Mount Lebanon Hospital, Beirut, Lebanon
| | | | - Marie Tanios Merheb
- Department of Endocrinology, Mount Lebanon Hospital, Beirut, Lebanon.,Mount Lebanon Hospital, Beirut, Lebanon
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Büyükakyüz N, Hillinger S, Weder W, Jungraithmayr W. Bronchopulmonary carcinoid with a single lymph node metastasis causing ectopic Cushing's syndrome. J Thorac Dis 2017; 9:E194-E196. [PMID: 28449502 DOI: 10.21037/jtd.2017.02.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Bronchial carcinoid tumors (BCTs) represent a subgroup of bronchopulmonary neuroendocrine tumors which have the ability to produce neuropeptides. Merely 2% of BCTs secrete ACTH and less than 1% of patients with Cushing's syndrome (CS) have a BCT. Typical BCTs rarely metastasize. We here present a patient with ectopic CS caused by a typical BCT, which metastasized into a lymph node. This case suggests that the diagnostic work up of CS should be wide and include ectopic ACTH-secreting BCT, and that ACTH secretion can be correlated to a more aggressive type of typical BCTs.
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Affiliation(s)
- Nilgün Büyükakyüz
- Department of Thoracic Surgery, University Hospital Zurich, Switzerland
| | - Sven Hillinger
- Department of Thoracic Surgery, University Hospital Zurich, Switzerland
| | - Walter Weder
- Department of Thoracic Surgery, University Hospital Zurich, Switzerland
| | - Wolfgang Jungraithmayr
- Department of Thoracic Surgery, University Hospital Zurich, Switzerland.,Department of Thoracic Surgery, Medical University Brandenburg, Germany
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