A Case of Pulmonary Carcinoid Tumor with a Superimposed Aspergilloma Presenting As a Covert Ectopic Adrenocorticotropic Hormone Syndrome

Abstract

Ectopic adrenocorticotropic hormone (ACTH) syndrome is a challenging diagnosis only responsible for approximately 10% of Cushing syndrome cases. It has been associated with a variety of benign and malignant tumors including a carcinoid tumor accompanied by aspergilloma in our case that was significantly difficult to be detected. We report a patient over 70 years old with uncontrolled hypertension and hypokalemia presenting with generalized edema. Laboratory results revealed ACTH-dependent Cushing syndrome, but imaging studies did not show any discrete lesions secreting ACTH. The petrosal to peripheral ACTH gradient resulted in no evidence of pituitary adenoma. As the only lesion suspicious for ectopic ACTH secretion was a right lower round cystic lesion that did not appear to be a carcinoid tumor on computed tomography scan of the chest, the patient underwent video-assisted thoracic surgical resection to provide a definitive diagnosis. The final diagnosis was a small ectopic ACTH-secreting carcinoid tumor with unusual superimposed aspergilloma in the periphery of the lung. Postoperatively, the abnormal endocrine levels were normalized, and all of the clinical symptoms and signs were ameliorated. This is an informative case of ectopic ACTH syndrome (EAS) that was the cause of hypokalemia, hypertension, metabolic alkalosis, and hypercortisolism despite its poorly specific cushingoid morphology and uncommon imaging findings. Therefore, we recommend that clinicians investigate any possible lesion as a potential source of EAS.

Dietary aflatoxin B1 (AFB1) reduces growth performance, impacting growth axis, metabolism, and tissue integrity in juvenile gilthead sea bream (Sparus aurata)

“…Adenohypophysis hormonal precursors such as pomca -MSH synthesis, and pomcb, responsible for ACTH production (Cardoso et al, 2011;Saccol et al, 2018a, b) did not differ among groups in our study. In this contest, it has been proposed that Aspergillus coexisting with carcinoid tumors might produce hypercortisolism in humans (Kim et al, 2017), thus existing precedents on putative effects AFB1 effects on a vertebrate HPI axis throughout ACTH-secreting non-pituitary solid tumors (Zhou et al, 2016). However, this fact did not meet our results regarding plasma cortisol levels.…”

Ectopic adrenocorticotropic hormone‐secreting carcinoid with solitary cryptococcosis in the lungs

“…This was thought to have caused the patient to become immunocompromised and to have developed isolated pulmonary cryptococcosis in the left lung apex. Past reports have described cases of systemic infection due to the immunocompromised state caused by ectopic ACTH‐producing tumors, 10 but cases of infection with isolated nodule only in the lungs, as in this case, are rare 11,12 . No elevated inflammatory response was seen preoperatively and sputum culture yielded negative results.…”

“…Past reports have described cases of systemic infection due to the immunocompromised state caused by ectopic ACTH-producing tumors, 10 but cases of infection with isolated nodule only in the lungs, as in this case, are rare. 11,12 No elevated inflammatory response was seen preoperatively and sputum culture yielded negative results. On CT, nodules in the apex and lingual region appeared difficult to diagnose by bronchoscopic lung biopsy.…”

Pulmonary <i>Scedosporium apiospermum</i> Infection with Pulmonary Tumorlet in an Immunocompetent Patient

“…It is associated with underlying lung disorders, such as chronic bronchitis and other inflammatory diseases, and has rarely been reported with normal lungs (9,10). To our knowledge, the co-occurrence of pulmonary tumorlet and pulmonary scedosporioma has never been reported, although there have been a few papers reporting the simultaneous existence of a tumorlet with pulmonary tuberculosis or pulmonary aspergillosis (11,12). We herein report the first case of scedosporioma with pulmonary tumorlet in an immunocompetent host.…”