Characterization of the somatostatin receptor subtype in a bronchial carcinoid tumor responsible for Cushing's syndrome.

Lefebvre, Henri; Jégou, Sylvie; Leroux, Philippe; Dero, M; Vaudry, Hubert; Kuhn, Jean-Marc

doi:10.1210/jcem.80.4.7714118

Cited by 17 publications

(11 citation statements)

References 15 publications

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“…Whereas normal scintigrams are observed in patients with ACTH-secreting pituitary tumors (9,11), SRS has demonstrated its ability to localize ACTH-secreting carcinoid tumors, most of these being located within the bronchial tree (Table 1). However, careful analysis of the 20 cases of ACTH-secreting carcinoids reported with sufficient details in English medical literature reveals that: 1) 12 were also evident using CT or MRI scanning (11, 12, 16, 18, 21-25); 2) 3 were not visualized initially because of the use of standard-cut CT, and these tumors were visualized when high-resolution CT of the chest was performed thereafter (17,19,20); and 3) SRS was useful only in confirming a suspected lesion seen with conventional imaging in 3 cases (13,15,26). Finally, SRS was of undeniable help and more sensitive than conventional imaging in only 2 (10%) cases (14,24).…”

Section: Discussionmentioning

confidence: 99%

“…ϩ ϩ De Herder (11) Pancreatic carcinoid (?) ϩ ϩ Iser (12) Bronchial carcinoid (20) ϩ ϩ Phlipponneau (13) Bronchial carcinoid (7) Ϯ ϩ Weiss (14) Bronchial carcinoid (10) Ϫ ϩ Lefebvre (15) Bronchial carcinoid (9) Ϯ ϩ Olario (16) Bronchial carcinoid (20) ϩ ϩ Tsagarakis (17) Bronchial carcinoid (6) ϩ ϩ Christin-Maitre (18) Bronchial carcinoid (10) ϩ ϩ Kristofferson (19) Bronchial carcinoid (20) ϩ ϩ Briganti (20) Bronchial carcinoid (20) ϩ ϩ Carreta (21) Bronchial carcinoid (10) ϩ ϩ Fernandez (22) Bronchial carcinoid (20) ϩ ϩ Mansi (23) Bronchial carcinoid (18) ϩ ϩ Segu (24) Midgut carcinoid (?) Ϫ ϩ Schrager (25) Bronchial carcinoid (?)…”

Section: Subjects and Methods Patientsmentioning

confidence: 99%

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Usefulness of Somatostatin Receptor Scintigraphy in Patients with Occult Ectopic Adrenocorticotropin Syndrome

Tabarin¹

1999

Journal of Clinical Endocrinology & Metabolism

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SRIF receptor scintigraphy (SRS) has been proposed for the localization of ectopic ACTH-secreting tumors responsible for Cushing's syndrome. However, in most cases reported, the tumors were also visible using conventional imaging. Therefore, the usefulness of SRS in localizing truly occult ectopic ACTH-secreting tumors remains unknown. We report the results of SRS in 12 patients with ectopic ACTH syndrome (EAS) and in whom the source of ACTH was occult at presentation despite carefully performed conventional imaging. The diagnosis of EAS was made by identification of an ACTH-secreting tumor during follow-up in 5 patients or given a pituitary-toperipheral ACTH ratio of 1.9 or less during petrosal sinus sampling combined with CRH injection and a negative pituitary magnetic resonance imaging (MRI). Whole-body planar SRS, using 111 In-pentetreotide, was performed 19 times in the 12 patients during initial workup and/or follow-up. Axial tomography imaging (single-photon emission-computed tomography) was performed in 7 of these. Conventional imaging was performed within a month of SRS, allowing comparison of the two approaches for the localization of the ACTHsecreting tumors. In addition, the response of plasma cortisol, after a single injection of 200 g octreotide, was studied in 6 patients.Five patients had negative SRS and conventional imaging studies. The source of ACTH secretion remains occult despite 10 -55 months of follow-up in four of these, whereas a 2-cm ileal carcinoid tumor, with liver micrometastases, was found at laparotomy in one patient, 14 months after presentation.SRS was positive in 4 of 12 patients. It was false-positive in 1 patient with follicular thyroid adenoma. Nineteen months after presentation, SRS identified liver metastasis that was also visible using MRI in one patient, but the primary tumor remains occult. SRS identified a 10-mm pancreatic tumor that became detectable, using computed tomography (CT) scanning 9 months later, in 1 patient; and 2 mediastinal lymph nodes of 10 mm, previously ignored by MRI, in another patient, whereas no tumor was detectable within the parenchymal lung. SRS had little influence on therapeutic options in these 2 patients, in whom no final diagnosis could be made. Repetition of SRS during the follow-up of patients with previously negative scintiscans was useless.Conventional imaging was positive in 6 of 12 patients. In the 2 patients with pancreatic tumor and isolated mediastinal lymph nodes, conventional imaging studies were interpreted as positive only after the results of SRS. One patient had liver metastasis that was also visible using SRS. Thin-section CT scanning visualized ACTHsecreting bronchial tumors and metastatic mediastinal lymph nodes of 10 -15 mm in diameter in 3 patients after 14 -72 months of followup, whereas SRS was negative.There was no evident relationship between the endocrine status (hyper-or eucortisolism) and the results of SRS. The in vivo response of plasma cortisol to octreotide correlated to the results of SRS in 4 of 6 c...

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Section: Discussionmentioning

confidence: 99%

Section: Subjects and Methods Patientsmentioning

confidence: 99%

Usefulness of Somatostatin Receptor Scintigraphy in Patients with Occult Ectopic Adrenocorticotropin Syndrome

Tabarin¹

1999

Journal of Clinical Endocrinology & Metabolism

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“…Reviewing published reports so far, eight of ten (including the present case) 'occult' tumors which were not visualized by standard radiographic imaging could be localized by this technique (23)(24)(25)(26)(27)(28)(29)(30)(31). Of the eight visualized tumors, five were bronchial carcinoids (26,(28)(29)(30)(31), one was an epigastric neuroendocrine tumor (27), one was a pancreatic islet cell tumor (24), and one was an ileal carcinoid (present case). From the published data, the size of the primary tumor first localized by pentetreotide scanning ranged from 6 to 25 mm, the largest one being a pancreatic islet cell neoplasm (24), which was not localized by initial CT or MRI but later confirmed by endoscopic ultrasound after localization with the pentetreotide scan.…”

Section: Discussionmentioning

confidence: 77%

Use of In-111 pentetreotide scintigraphy in the diagnosis of a midgut carcinoid causing Cushing's syndrome

Segu

Mahvi²,

Wilson³

et al. 1997

European Journal of Endocrinology

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A 57-year-old man presented with clinical features of hypercortisolism and was diagnosed with ACTHdependent Cushing's syndrome. Biochemical testing showed partial suppression of urinary free cortisol with high dose dexamethasone. Initial computed tomography (CT) of the chest and abdomen, and magnetic resonance imaging of the pituitary were negative. In-111 pentetreotide scintigraphy with single photon emission computerized tomography revealed two 'hot' lesions in the abdomen which were then confirmed by subsequent directed thin-slice abdominal CT and small bowel barium study. At surgery, two segments of ileum, adjoining mesentery and lymph nodes were resected. Histopathology was consistent with a malignant carcinoid tumor of the ileum which stained intensely for ACTH. Plasma ACTH, and serum and urinary cortisol normalized postoperatively. To our knowledge, this is the first reported case of ileal carcinoid tumor causing Cushing's syndrome with premortem diagnosis. Another unique feature of this case is that In-111 pentetreotide scan provided the decisive clue to localization of the tumor. European Journal of Endocrinology 137 79-83

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“…9,10 The somatostatin receptor binding sites seem to be predominantly of the SST2 type based on the somatostatin analog affinity in vitro and the clinical response. 11 Somatostatin receptor scintigraphy to find localized neuroendocrine tumors can be useful. Negative results are observed in patients with ACTH-secreting pituitary tumors, 12 so somatostatin receptor scintigraphy can be used for the detection of the occult tumor if conventional imaging studies failed to find the tumor.…”

Section: Discussionmentioning

confidence: 99%

A Discrepancy Between Somatostatin Receptor Scintigraphy and Treatment Response of Somatostatin Analogs in a Case of Occult Adrenocorticotropic Syndrome

Huang

2003

The Endocrinologist

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Ectopic adrenocorticotropic (ACTH) syndrome is a relatively rare cause of Cushing's syndrome. Sometimes the tumor cannot be found. Unfortunately, medical treatment is sometimes ineffective and bilateral adrenalectomy becomes necessary. We report a case of Cushing's syndrome with the clinical and biochemical characteristics of ectopic ACTH syndrome, but the source of the ACTH could not be found. Somatostatin receptor scintigraphy was negative. Somatostatin analog was tried after a positive Sandostatin test. Cushing's syndrome improved. Six months later this treatment failed.

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Characterization of the somatostatin receptor subtype in a bronchial carcinoid tumor responsible for Cushing's syndrome.

Cited by 17 publications

References 15 publications

Usefulness of Somatostatin Receptor Scintigraphy in Patients with Occult Ectopic Adrenocorticotropin Syndrome

Usefulness of Somatostatin Receptor Scintigraphy in Patients with Occult Ectopic Adrenocorticotropin Syndrome

Use of In-111 pentetreotide scintigraphy in the diagnosis of a midgut carcinoid causing Cushing's syndrome

A Discrepancy Between Somatostatin Receptor Scintigraphy and Treatment Response of Somatostatin Analogs in a Case of Occult Adrenocorticotropic Syndrome

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