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Channaiah CY, Memon SS, Lila AR, Sarathi V, Karlekar M, Barnabas R, Patil VA, Sharma A, Phadte A, Malhotra G, Shah N, Bandgar T. Diagnostic performance of various imaging modalities in localizing ectopic ACTH syndrome: A systematic review. ANNALES D'ENDOCRINOLOGIE 2024:S0003-4266(24)00109-4. [PMID: 39002895 DOI: 10.1016/j.ando.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 06/06/2024] [Accepted: 07/07/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND To elucidate the role of various imaging modalities for tumor localization in ectopic ACTH Cushing's syndrome (EAS). DESIGN AND METHOD Systematic review of the literature published between January 2015-2024 was performed. Patients (290 EAS patients, 23.8% Occult) who underwent contrast enhanced CT (CECT) and at least one PET/CT-scan (68Ga-SSTR, FDG and/or F-DOPA) were included. RESULTS The sensitivity for identifying EAS tumor was comparable across CECT (63.1%, n=290), SSTR-PET/CT (58.2%, n=187), and FDG-PET/CT (57.6%, n=191), but was poor for DOPA-PET/CT (30.8%, n=26). Sensitivity for detecting metastasis was also comparable across CECT (78%, n=73), SSTR-PET/CT (85.3%, n=41), and FDG-PET (73.7%, n=38). For localised lesions, sensitivity as per etiology and grade of NET were similar for three scans, with exception of Thymic NET and grade 1 NET where CECT was better than FDG PET/CT. In patients not localised on CECT, sensitivity of SSTR PET/CT was 33.3% (vs. 18.9% FDG-PET/CT) whereas for patients negative on CECT and FDG-PET, sensitivity of SSTR-PET/CT was 15%. In cases where CECT and SSTR-PET/CT failed to localize, the sensitivities of FDG-PET/CT and DOPA-PET/CT were only 5.7% (2/35) and 0% (0/9), respectively. SSTR-PET/CT has a distinct advantage with significantly lesser false positive (FP) lesions (2.6%, mostly in thyroid/or pancreas). In comparison, CECT and FDG-PET/CT had FP ∼11% (mostly in lung and/or mediastinum), most of which were negative on SSTR-PET/CT. CONCLUSIONS As per the current evidence, SSTR-PET/CT can be considered as the scan of choice in EAS evaluation, and further research is needed as one-fourth of the lesions remain occult.
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Affiliation(s)
- Chethan Yami Channaiah
- Department of Endocrinology, Seth GS Medical College, KEM Hospital, 400012 Parel, Mumbai, India
| | - Saba Samad Memon
- Department of Endocrinology, Seth GS Medical College, KEM Hospital, 400012 Parel, Mumbai, India
| | - Anurag Ranjan Lila
- Department of Endocrinology, Seth GS Medical College, KEM Hospital, 400012 Parel, Mumbai, India
| | - Vijaya Sarathi
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, 560066 Bengaluru, India
| | - Manjiri Karlekar
- Department of Endocrinology, Seth GS Medical College, KEM Hospital, 400012 Parel, Mumbai, India
| | - Rohit Barnabas
- Department of Endocrinology, Seth GS Medical College, KEM Hospital, 400012 Parel, Mumbai, India
| | - Virendra Ashokrao Patil
- Department of Endocrinology, Seth GS Medical College, KEM Hospital, 400012 Parel, Mumbai, India
| | - Anima Sharma
- Department of Endocrinology, Seth GS Medical College, KEM Hospital, 400012 Parel, Mumbai, India
| | - Aditya Phadte
- Department of Endocrinology, Seth GS Medical College, KEM Hospital, 400012 Parel, Mumbai, India
| | - Gaurav Malhotra
- Radiation medical Centre, Bhabha Atomic Research Centre, 400012 Mumbai, India
| | - Nalini Shah
- Department of Endocrinology, Seth GS Medical College, KEM Hospital, 400012 Parel, Mumbai, India
| | - Tushar Bandgar
- Department of Endocrinology, Seth GS Medical College, KEM Hospital, 400012 Parel, Mumbai, India.
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Hao Z, Ding J, Huo L, Luo Y. ACTH-Independent Cushing’s Syndrome Caused by an Ectopic Adrenocortical Adenoma in the Renal Hilum. Diagnostics (Basel) 2022; 12:diagnostics12081937. [PMID: 36010286 PMCID: PMC9407005 DOI: 10.3390/diagnostics12081937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/05/2022] [Accepted: 08/09/2022] [Indexed: 11/25/2022] Open
Abstract
We report a rare case of Cushing’s syndrome induced by an ectopic adrenocortical adenoma. A 57-year-old woman was diagnosed with adrenocorticotropic hormone (ACTH)-independent Cushing’s syndrome based on clinical manifestation and laboratory information. She was found to have a mass in the left renal hilum via contrast-enhanced computed tomography (CT). The mass was negative, as seen in somatostatin receptor imaging with 99mTc-hydrazinonicotinyl-Tyr3-octreotide (HYNIC-TOC), and showed mild fluorodeoxyglucose (FDG) activity via positron emission tomography (PET)/CT. The results of adrenal venous sampling suggested a left-side adrenal origin of hypercortisolism, possibly secreted by the mass in the renal hilum. Histopathology after surgical resection of the mass confirmed an ectopic adrenocortical adenoma, which was responsible for the patient’s Cushing’s syndrome. During the 8-month follow-up after surgery, no recurrence of Cushing’s syndrome was found.
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Affiliation(s)
- Zhixin Hao
- Department of Nuclear Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing 100730, China
| | - Jie Ding
- Department of Nuclear Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing 100730, China
| | - Li Huo
- Department of Nuclear Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing 100730, China
| | - Yaping Luo
- Department of Nuclear Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing 100730, China
- Correspondence: ; Tel.: +86-010-69155513
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