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Ectopic ACTH secretion is a rare cause of hypercortisolism. Induced metabolic disturbances are often serious, and the management of such patients may be difficult. We report here our experience with four medullary thyroid carcinoma (MTC) patients with distant metastases in whom an ectopic ACTH syndrome occurred. The clinical presentation was significant by the severity and the rapidity of the hypercortisolism. Diagnosis and follow-up were realized by measurements of plasma cortisol, urinary free cortisol, urinary 17-hydroxycorticosteroid, plasma ACTH, plasma LPH, serum calcitonin and carcino-embryonic antigen. Initial treatment with adrenalytic medical therapy failed to control the disease. Only bilateral adrenalectomy cured the excessive cortisol production, and for a long time despite tumor progression. In conclusion, bilateral adrenalectomy should be considered in MTC patients with Cushing's syndrome even at the stage of distant spread. In fact, with regard to the slow growth rate of most MTC's, they may survive for years.

We report a case of liver amoebic abscesses in a 58-year-old man referred for a FDG PET/CT with an initial diagnosis of secondary hepatic lesions. This patient, coming from Sri Lanka, presented with fever and shivers, pain in the right flank, vomiting, and diarrhea for a month. The FDG PET/CT showed a hepatic heterogeneous uptake with multiple cold lesions surrounded by a faint hypermetabolism. As this result was not typical of hepatic metastases, a hepatic biopsy was performed leading to the diagnosis of amoebic abscess.

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