Cushing's Syndrome due to a Bronchial ACTH-Secreting Carcinoid Successfully Treated With Radiofrequency Ablation (RFA)

Corsello, Salvatore Maria; Senes, Paola; Iezzi, Roberto; Rufini, Vittoria; Congedo, Maria Teresa; Paragliola, Rosa Maria; Pontecorvi, Alfredo

doi:10.1210/jc.2013-4359

Cited by 13 publications

(5 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Even procedures like thermal radiofrequency ablations have been performed with the help of 18 F-FDG PET guidance that have led to rapid resolution of hypercortisolism and improvement of symptoms [50].…”

Section: Discussionmentioning

confidence: 99%

PET imaging in ectopic Cushing syndrome: a systematic review

et al. 2015

View full text Add to dashboard Cite

Cushing syndrome due to endogenous hypercortisolism may cause significant morbidity and mortality. The source of excess cortisol may be adrenal, pituitary, or ectopic. Ectopic Cushing syndrome is sometimes difficult to localize on conventional imaging like CT and MRI. After performing a multilevel thoracoabdominal imaging with CT, the evidence regarding the use of radiotracers for PET imaging is unclear due to significant molecular and etiological heterogeneity of potential causes of ectopic Cushing's syndrome. In our systematic review of literature, it appears that GalLium-based (Ga68) somatostatin receptor analogs have better sensitivity in diagnosis of bronchial carcinoids causing Cushing syndrome and FDG PET appears superior for small-cell lung cancers and other aggressive tumors. Further large-scale studies are needed to identify the best PET tracer for this condition.

show abstract

Section: Discussionmentioning

confidence: 99%

PET imaging in ectopic Cushing syndrome: a systematic review

et al. 2015

View full text Add to dashboard Cite

show abstract

“…We identified 2 case reports of Cushing syndrome treated with EUS-guided RFA. In the first case, EAS due to a 7-mm ACTH-secreting endobronchial carcinoid was treated with RFA as a bridge to lobectomy [ 9 ]. In the second case, a non-ACTH-dependent 2.8-cm cortisol-producing adrenal nodule required repeated attempts at RFA prior to temporary biochemical remission [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Cushing Syndrome due to a Pancreatic Neuroendocrine Tumor Treated With Radiofrequency Ablation

et al. 2023

View full text Add to dashboard Cite

Delayed diagnosis of Cushing syndrome (CS) results in advanced disease, treatment delays, and poor outcomes. We present a patient with ectopic ACTH syndrome (EAS) from a pancreatic neuroendocrine tumor (NET) whose care posed diagnostic and therapeutic challenges. A 59-year-old female with classic Cushing stigmata, biochemical evidence of ACTH-dependent hypercortisolism, and a 5-mm pituitary lesion presented for inferior petrosal sinus sampling, which was contraindicated due to non-ST elevation myocardial infarction and acute/subacute strokes. Whole-body computed tomography (CT) scan was unrevealing, but elevations in chromogranin A and proopiomelanocortin (POMC) concentrations suggested EAS. Positron emission tomography-CT with gallium 68-DOTATATE demonstrated a 7-mm pancreatic tail lesion, suspicious for a pancreatic NET. The patient was not a surgical candidate and treatment with ketoconazole was complicated by hepatoxicity. Endoscopic ultrasound-guided biopsy and radiofrequency ablation of the lesion was pursued. Pathology confirmed ACTH immunoreactive low-grade pancreatic NET. Post procedure, sustained normalization of ACTH and cortisol was achieved. This case supports the utility of POMC measurements in the differential diagnosis of CS and the use of advanced nuclear imaging for tumor localization. For patients with functional pancreatic NET who are poor surgical candidates or intolerant of pharmacotherapy, novel endoscopic ablation may offer a low-risk therapeutic option and should be further investigated.

show abstract

“…Therefore, it requires a comprehensive multidisciplinary discussion of the patient when appropriate therapy such as radiotherapy, ablation, etc. is used clinically to treat ectopic EAS lesions (18). As mentioned in PATIENT DESCRIPTION, we should comprehensively consider the patient's condition and choose the appropriate treatment plan.…”

Section: Discussionmentioning

confidence: 99%

“…Meanwhile, chest images showed only slight thickening of the bilateral adrenal glands without obvious signs of hyperplasia. The patient underwent 68 Ga-DOTATATE (Figure 1), and 18 F-FDG PET-CT. 68 Ga-DOTATATE PET-CT did not show significant uptake while 18 F-FDG PET-CT showed mild radiotracer uptake (standard uptake value 2.2 g/ml).…”

Section: Patient Descriptionmentioning

confidence: 99%

Case report: Radiofrequency ablation combined with biopsy for Cushing’s syndrome due to ectopic ACTH lesions in the lung

et al. 2022

View full text Add to dashboard Cite

Lung carcinoid tumor is one of the major tumors causing ectopic ACTH syndrome, and the most common clinical treatment is surgical resection of the lesion. We herein report a suspected pulmonary carcinoid tumor with difficulty in surgical resection and poor response to drug therapy, which was successfully treated with radiofrequency ablation combined with intraoperative biopsy of the lesion. A 48-year-old female patient, with hypercortisolism (reddening of the face, full moon face, hirsutism, acne, and weight gain) detected three months ago. Small and high-dose dexamethasone suppression tests were not suppressed, Cushing’s syndrome was under consideration. PET-CT examination suggested mild FDG uptake in two nodules in the anterior basal segment of the lower lobe of the right lung, the possibility of ectopic ACTH lesions was considered because of the clinical presentation. Due to difficult surgical approach of the lesion, high risk of surgery and the patient’s anxiety, CT-guided thermal ablation combined with puncture biopsy was considered to treat the lesions. Image-guided thermal ablation can effectively inactivate ectopic ACTH lesions in the lung, rapidly improve the symptoms of high cortisol, and can be combined with biopsy for pathologic diagnosis. Therefore, this technique can be considered for treating pulmonary ACTH lesions that are difficult to resect surgically.

show abstract

Cushing's Syndrome due to a Bronchial ACTH-Secreting Carcinoid Successfully Treated With Radiofrequency Ablation (RFA)

Cited by 13 publications

References 19 publications

PET imaging in ectopic Cushing syndrome: a systematic review

PET imaging in ectopic Cushing syndrome: a systematic review

Cushing Syndrome due to a Pancreatic Neuroendocrine Tumor Treated With Radiofrequency Ablation

Case report: Radiofrequency ablation combined with biopsy for Cushing’s syndrome due to ectopic ACTH lesions in the lung

Contact Info

Product

Resources

About