Radiotherapy of ectopic ACTH syndrome due to thoracic carcinoids

From 1984 to 1990, six patients with histologically and endocrinologically proven ectopic ACTH syndrome were treated in our department. The lesion in five patients was clinically evident, but in the other was occult. All lesions were located within the chest. Four were thymic carcinoid and the other two were bronchial carcinoids. Most of the patients had typical clinical manifestations of Cushing's syndrome. Laboratory tests including histopathological examination confirmed the diagnosis of ectopic ACTH syndrome. The treatment consisted of surgical removal of the mass supplemented by radiotherapy. The results showed that after treatment all patients had satisfactory remission. Two bronchial carcinoid patients have been living for 40 and 88 months respectively without recurrence. Among 4 thymic carcinoid patients, only one has been living with no tumor for 34 months. One patient had recurrence and the other 2 died 32 and 50 months after the treatment respectively. However, the symptoms of two thymic carcinoid patients had not been relieved at all until radiotherapy was given. This paper discusses the method, dose and indications of radiotherapy. It should be pointed out that the prognosis of bronchial carcinoids is good while that of thymic carcinoids is relatively poor.

[Radiotherapy of ectopic ACTH syndrome]

From 1984 to 1990, 6 patients with histologically and hormone assay proved ectopic ACTH syndrome were treated. All these lesions occurred in the chest: 4 thymic carcinoids and the other 2 bronchial carcinoids. The patients all had Cushing's syndrome. Treatment consisted of operation plus radiotherapy. The results showed four completely relieved, one improved and is alive with tumor for 4 years and the other relieved for 2 years and 8 months, then died of local recurrence. The indications, dose and method of radiotherapy are discussed.

Cushing's syndrome due to ectopic ACTH production by a nasal paraganglioma

A patient is described with Cushingoid features and a tumor of the paranasal sinuses. Laboratory studies revealed hyperglycemia, hypokalemia, alkalosis, hypercortisolemia, and elevated serum ACTH levels. The cortisol level increased briskly in response to parenteral ACTH, but was only partially suppressed by dexamethasone. Microscopically, the tumor was found to be a paraganglioma containing many neurosecretory granules.. Treatment with methyrapone, o,p'DDD, and irradiation of the tumor resulted in a lasting remission. It is concluded that this unique patient suffered from Cushing's syndrome due to ectopic ACTH production by a paraganglioma of the paranasal sinuses.