Bilateral symmetrical adrenal hypermetabolism on FDG PET/CT due to Cushing syndrome in well differentiated neuroendocrine carcinoma

Aktaş, Gül Ege; Demir, Selin Soyluoğlu; Sarıkaya, Ali

doi:10.1016/j.remn.2015.08.011

Cited by 2 publications

(3 citation statements)

References 13 publications

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“…Aktas et al suggested the use of 18F-FDG PET/CT scan to detect the ectopic site of ACTH-secreting tumors when ectopic Cushing's syndrome is the most probable diagnosis. In our case, 18F-FDG PET/CT scan showed diffused and increased uptake in bilateral adrenal hyperplasia with low FDG affinity in neuroendocrine mass indicating the tumor to be of low grade (8). According to Matejka et al, somatostatin receptor scintigraphy, using 111Indium-octreotide and 99mTechnetium-albumin macroaggregates, can detect undetectable ACTH-secreting neuroendocrine carcinoid tumors (9).…”

Section: Case Reportmentioning

confidence: 63%

Overlapping Between Thymus Neuroendocrine Carcinoma as an Ectopic Cushing Syndrome and Exogenous Cushing’s Syndrome: A Case Report

Faraji¹,

Tekantapeh²

2019

Turk J Endocrinol Metab

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O Ov ve er rl la ap pp pi in ng g B Be et tw we ee en n T Th hy ym mu us s N Ne eu ur ro oe en nd do oc cr ri in ne e C Ca ar rc ci in no om ma a a as s a an n E Ec ct to op pi ic c C Cu us sh hi in ng g S Sy yn nd dr ro om me e a an nd d E Ex xo og ge en no ou us s C Cu us sh hi in ng g' 's s S Sy yn nd dr ro om me e: : A A C Ca as se e R Re ep po or rt t E Ek kt to op pi ik k C Cu us sh hi in ng g S Se en nd dr ro om mu u O Ol la an n T Ti im mu us s N Nö ör ro oe en nd do ok kr ri in n K Ka ar rs si in no om mu u i il le e E Ek kz zo oj je en n C Cu us sh hi in ng g S Se en nd dr ro om mu u Ö Ör rt tü üş şm me es si i: : B Bi ir r O Ol lg gu u S Su un nu um mu u Tabriz University of Medical Science, Endocrine Research Center, Tabriz, IranCushing's syndrome results from an excess production of the hormone cortisol by the adrenal gland. It can be distinguished into ectopic and exogenous, also known as iatrogenic, depending on whether the cause exists inside or outside the body, respectively. The exogenous disease can occur due to the intake of corticosteroids medication. Thymic neuroendocrine carcinoma is one of the most common etiologies of ectopic Cushing's syndrome. We report a case of overlapping condition between ectopic and exogenous Cushing's syndromes and discussed the invasive characteristics of thymic low-grade neuroendocrine carcinoma and its capability to transform to a high-grade carcinoma. A 29-year-old male patient was presented with Cushing's symptoms and hypokalemia. He had a history of repeated weekly dexamethasone injections during last year to treat generalized weakness, without physician's prescription. He reported relative improvement in his general condition with the use of corticosteroids. The case was managed as an iatrogenic Cushing's syndrome because of excessive use of corticosteroids and low cortisol levels despite suppressed ACTH. He presented with weakness and hypercortisolism eight months after the discontinuation of dexamethasone with an ACTH > 1,500 pg/mL; these features were in favor of ectopic Cushing's syndrome. Also, a thymus mass was detected on imaging. We performed thymus resection due to the early stage of the syndrome and there was no sign of metastasis to other organs. Pathology reported a thymic carcinoid tumor. Normal calcium, PTH, prolactin, and gastrin levels ruled out the involvement of MEN I. Tumor cells were immunoreactive for ACTH, and a whole body scan was performed. An 18-month delay in visiting the doctor and not undergoing whole body scan led to a severe relapse with full-blown Cushing's syndrome, generalized bone pain, pulmonary metastatic nodules, hyperplasic adrenals, and widespread bone metastases as demonstrated by the whole body bone scan. Bilateral adrenalectomy was performed. Metastatic neuroendocrine carcinoma grade III was reported in the pathology. After consultation with an oncologist, palliative chemotherapy with octreotide was started. He died because of pulmonary metastases, severe opportunistic organism infections, and septic shock. This ca...

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Section: Case Reportmentioning

confidence: 63%

Overlapping Between Thymus Neuroendocrine Carcinoma as an Ectopic Cushing Syndrome and Exogenous Cushing’s Syndrome: A Case Report

Faraji¹,

Tekantapeh²

2019

Turk J Endocrinol Metab

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“…This stage IV diagnosis affects patient management significantly. The adrenal gland is one of the most common sites of metastasis in patients with lung cancer, and NSCLC metastases cause about 30% of all adrenalectomies [6,[17][18][19]. Because adrenal adenomas also have a high incidence (around 9%) in general population [5], AL characterization is difficult in some NSCLC cases.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, postmortem studies in these patients report a high incidence of metastatic adrenal lesions. However, because adrenal adenomas also have a high frequency (9%) in general population, in some NSCLC cases, benign adenoma and metastasis cannot be adequately differentiated using imaging methods [3][4][5][6][7]. A lesion with a density of <10 Hounsfield units (HU) on unenhanced computed tomography (CT) is described with high accuracy as lipid-rich adrenal adenoma.…”

Section: Introductionmentioning

confidence: 99%

An exceptional group of non-small cell lung cancer difficult to diagnose: Evaluation of lipid-poor adrenal lesions

Şimşek

Arslan

Dag

2019

Bosn J of Basic Med Sci

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In some non-small cell lung cancer (NSCLC) patients, lipid-poor adrenal adenomas cannot be adequately differentiated from metastases using imaging methods. Invasive diagnostic procedures also have a low negative predictive value (NPV) in such cases. The current study aims to establish a specific and clinically practical metabolic parameter for lipid-poor adrenal lesions (ALs) in NSCLC patients. This diagnostic approach may prevent unnecessary abdominal enhanced computed tomography (CT), magnetic resonance imaging, or invasive diagnostic procedures. Sixty-four NSCLC patients with 69 lipid-poor ALs and 28 control patients with 30 benign lipid-poor ALs, who underwent FDG-PET/CT, were retrospectively reviewed. Two morphological and four metabolic parameters were analyzed in FDG-PET/CT images of NSCLC and control patients. Baseline and post-chemotherapy images of 64 NSCLC patients were re-evaluated according to the PERCIST 1.0. In cases where ALs could not be differentiated, follow-up FDG-PET/CT images were re-examined. The receiver operating characteristic (ROC) curve method was used for the evaluation of diagnostic parameters. Out of 69 ALs, 39 were determined as metastatic lesions (adrenal metastasis), while 30 lesions were considered non-metastatic (adrenal adenomas). The mean attenuation value, SUVmax AL/SUVmax primary tumor, SUVmax, SUVmax AL/liver, and SUVmax AL/SUVmean liver were significantly different between metastatic and benign ALs from NSCLC patients. The SUVmax AL/SUVmean liver ≥1.81 had the best positive (PPV, 94.3%) and negative (NPV, 82.4%) predictive values, and the highest specificity (93.3%), sensitivity (84.6%) and accuracy (86.9%). Lipid-poor ALs with SUVmax AL/SUVmean liver ≥1.81 can be accepted as malignant in NSCLC. However, if SUVmax AL/SUVmean liver is <1.81, a pathologic examination is required. Utilizing this cut-off value to decide on adrenal core biopsy may prevent its unnecessary use. Moreover, this diagnostic approach can save time and reduce the healthcare costs.

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Bilateral symmetrical adrenal hypermetabolism on FDG PET/CT due to Cushing syndrome in well differentiated neuroendocrine carcinoma

Cited by 2 publications

References 13 publications

Overlapping Between Thymus Neuroendocrine Carcinoma as an Ectopic Cushing Syndrome and Exogenous Cushing’s Syndrome: A Case Report

Overlapping Between Thymus Neuroendocrine Carcinoma as an Ectopic Cushing Syndrome and Exogenous Cushing’s Syndrome: A Case Report

An exceptional group of non-small cell lung cancer difficult to diagnose: Evaluation of lipid-poor adrenal lesions

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