68Ga-DOTATOC PET/CT in detecting neuroendocrine tumours responsible for initial or recurrent paraneoplastic Cushing’s syndrome

Benesty, Ophélie Bélissant; Nataf, Valérie; Ohnona, Jessica; Michaud, Laure; Zhang-Yin, Jules; Bertherat, Jérôme; Chanson, Philippe; Reznik, Yves; Talbot, Jean‐Noël; Montravers, F.

doi:10.1007/s12020-019-02098-2

Cited by 12 publications

(9 citation statements)

References 27 publications

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“…A recent report, having included six new EAS cases, suggested that the sensitivity of 68 Ga -SSTR PET/CT for identifying ectopic ACTHsecreting lesions (including multiple metastases) was lower than previously reported, with a sensitivity of 64% as compared to 69% for CT (183). Our literature search, on the performance of 68 Ga -SSTR-PET/CT, identified 51 patients with possible occult and covert EAS at initial morphological imaging, assuming that the diagnosis of occult/covert EAS was based on variable imaging procedures across the studies (149,183,187,188,189,190): 68 Ga -SSTR PET/CT led to the discovery of the source of EAS in 29 out of 51 patients, indicating a sensitivity of only 57%. Despite its limitations, we consider that 68 Ga -SSTR PET/CT may be a useful complementary tool in the difficult context of occult EAS, but evaluation of its performance deserves additional studies, including a significantly larger number of unselected EAS patients.…”

Section: Pet/ct Using Gallium-68 Labeled Somatostatin Receptor Ligandsmentioning

confidence: 94%

MANAGEMENT OF ENDOCRINE DISEASE: Cushing’s syndrome due to ectopic ACTH secretion: an expert operational opinion

Young

Haissaguerre

Viera-Pinto

et al. 2020

European Journal of Endocrinology

158

186

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Ectopic ACTH syndrome (EAS) is rare but is frequently a severe condition because of the intensity of the hypercortisolism that may be dissociated from the tumoral condition. EAS should often be considered as an endocrine emergency requiring an emergency response both in terms of diagnostic procedures and therapeutic interventions. Patient management is complex and necessitates dual skills, in the diagnosis and treatment of CS and in the specific management of neuroendocrine tumors (NET). Therefore, initial management should be performed ideally by experienced endocrinology teams in collaboration with specialized hormonal laboratory, modern imaging platforms and intensive care units. Diagnostic procedures vary according to the endocrine and tumoral contexts but should be reduced to a minimum in intense hypercortisolism. Preventive and curative treatments of cortisol-induced comorbidities, non-specific management of hypercortisolism and etiological treatments should be considered simultaneously. Therapeutic strategies vary according to (1.) the intensity of hypercortisolism, the general condition of the patient and associated comorbidities and (2.) the tumoral status, ranging from resectable ACTH secreting tumors to non-resectable metastatic endocrine tumors or occult tumors. The ideal treatment is complete excision of the ACTH-secreting tumor that can be performed rapidly or after preoperative preparation using cortisol-lowering drugs. When this is not possible, the therapeutic strategy should be discussed by a multidisciplinary experienced team in a personalized perspective and include variable combinations of pharmacological agents, bilateral adrenalectomy and non-specific tumoral interventions. Here we discuss the diagnosis and therapeutic strategies including the modern, currently available tools and emphasize on the operational effectiveness of care.

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Section: Pet/ct Using Gallium-68 Labeled Somatostatin Receptor Ligandsmentioning

confidence: 94%

MANAGEMENT OF ENDOCRINE DISEASE: Cushing’s syndrome due to ectopic ACTH secretion: an expert operational opinion

Young

Haissaguerre

Viera-Pinto

et al. 2020

European Journal of Endocrinology

158

186

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“…In clinical laboratories, endocrine analytes are indicators of thyroid, pancreatic, and cortical function. They are frequently measured for diagnosis of diseases such as hyperthyroidism, hypothyroidism, diabetes, and Cushing's syndrome 1‐3 . Owing to their important role in the diagnosis and treatment of endocrine diseases, it is crucial to precisely and accurately evaluate their analytical performance.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the analytical performance of endocrine analytes using sigma metrics

Yanming

Cao

Liu

et al. 2020

Clinical Laboratory Analysis

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Background (a) To evaluate the clinical performance of endocrine analytes using the sigma metrics (σ) model. (b) To redesign quality control strategies for performance improvement. Methods The sigma values of the analytes were initially evaluated based on the allowable total error (TEa), bias, and coefficient of variation (CV) at QC materials level 1 and 2 in March 2018. And then, the normalized QC performance decision charts, personalized QC rules, quality goal index (QGI) analysis, and root causes analysis (RCA) were performed based on the sigma values of the analytes. Finally, the sigma values were re‐evaluated in September 2018 after a series of targeted corrective actions. Results Based on the initial sigma values, two analytes (FT3 and TSH) with σ > 6, only needed one QC rule (13S) with N2 and R500 for QC management. On the other hand, seven analytes (FT4, TT4, CROT, E2, PRL, TESTO, and INS) with σ < 4 at one QC material level or both needed multiple rules (13S/22S/R4S/41S/10X) with N6 and R10‐500 depending on different sigma values for QC management. Subsequently, detailed and comprehensive RCA and timely corrective actions were performed on all the analytes base on the QGI analysis. Compared with the initial sigma values, the re‐evaluated sigma metrics of all the analytes increased significantly. Conclusions It was demonstrated that the combination of sigma metrics, QGI analysis, and RCA provided a useful evaluation system for the analytical performance of endocrine analytes.

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“…These drugs include ketoconazole, mitotane, metyrapone, and aminoglutethimide (27). Despite several collateral effects, such as nausea, hepatotoxicity, and hypogonadism, ketoconazole is usually the most tolerated (22); instead, metyrapone, which results in eucortisolemia in 50% of patients, may cause hirsutism.…”

Section: The Imaging Evaluation Should Include Not Only a Brain Mri Tmentioning

confidence: 99%

“…Despite several collateral effects, such as nausea, hepatotoxicity, and hypogonadism, ketoconazole is usually the most tolerated (22); instead, metyrapone, which results in eucortisolemia in 50% of patients, may cause hirsutism. Mifepristone, which competes with the glucocorticoid receptor, has recently shown excellent results in both clinical and laboratory data (27). Mitotane, with its cytotoxic effect on adrenocortical cells, can be used for as long term therapy and in double or triple combinations with other drugs (25).…”

Section: The Imaging Evaluation Should Include Not Only a Brain Mri Tmentioning

confidence: 99%

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Ectopic ACTH Secretion in a Child With Metastatic Ewing's Sarcoma: A Case Report

et al. 2020

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Ectopic ACTH syndrome is rare in pediatric age. Sarcomas that cause Ectopic ACTH Syndrome (EAS) are even more uncommon. Currently, only three cases of EAS caused by Ewing' sarcoma have been reported. We detail a 10-year-old boy with Cushing's syndrome symptoms caused by ectopic ACTH production by a metastatic Ewing's sarcoma of the right ischio-pubic and ileo-pubic branches. The rapid appearance of cushingoid symptoms, with significant weight gain, acne, hirsutism, and hypercortisolism were implications of ectopic ACTH production as paraneoplastic Cushing's Syndrome. The very high levels of ACTH and non-suppression at the high dose dexamethasone test confirmed the clinical suspicion. We underline the possibility EAS was caused by an ACTH-secreting tumor, including soft tissue sarcomas.

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68Ga-DOTATOC PET/CT in detecting neuroendocrine tumours responsible for initial or recurrent paraneoplastic Cushing’s syndrome

Cited by 12 publications

References 27 publications

MANAGEMENT OF ENDOCRINE DISEASE: Cushing’s syndrome due to ectopic ACTH secretion: an expert operational opinion

MANAGEMENT OF ENDOCRINE DISEASE: Cushing’s syndrome due to ectopic ACTH secretion: an expert operational opinion

Evaluation of the analytical performance of endocrine analytes using sigma metrics

Ectopic ACTH Secretion in a Child With Metastatic Ewing's Sarcoma: A Case Report

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