Cushing's syndrome secondary to bronchopulmonary carcinoid tumor: Report of two cases and literature review

Matos, Leandro Luongo de; Trufelli, Damila Cristina; Neves-Pereira, João Carlos das; Danel, Claire; Riquet, Marc

doi:10.1016/j.lungcan.2006.05.019

Cited by 25 publications

(17 citation statements)

References 34 publications

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“…Lung carcinoid tu- mours are non-smoking associated rare tumours, accounting for 1-5% of all pulmonary neoplasms and 12-15% of carcinoid tumours overall [2,10,11]. They are more frequent in Caucasian males, the male-to-female ratio is 2:1, and affect individuals in a wide age range with a peak incidence in the fifth decade [5,6].…”

Section: Discussionmentioning

confidence: 99%

“…They have their origin in the bronchial mucosa, in the neurosecretory cells -Kulchistky cells -and are classified as low grade malignant neoplasms because they can potentially cause both local invasion and local recurrence and the occurrence of occasional metastases in extrathoracic sites [5,6]. Lung carcinoids are ranked typical and atypical, according to the histopathological criteria of the World Health Organization (WHO) [10] and, at present, their staging is named the same way as the lung bronchogenic carcinoma [6,12]. The incidence of CS in lung carcinoid tumours is about 1% [10].…”

Section: Discussionmentioning

confidence: 99%

“…Lung carcinoids are ranked typical and atypical, according to the histopathological criteria of the World Health Organization (WHO) [10] and, at present, their staging is named the same way as the lung bronchogenic carcinoma [6,12]. The incidence of CS in lung carcinoid tumours is about 1% [10]. Conversely, the incidence of lung carcinoid tumours as the cause of CS remains variable in the literature [10].…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of CS in lung carcinoid tumours is about 1% [10]. Conversely, the incidence of lung carcinoid tumours as the cause of CS remains variable in the literature [10].…”

Section: Discussionmentioning

confidence: 99%

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Pitfalls in the Diagnosis of Ectopic Adrenocorticotropic Hormone Syndrome: A Case Report

Gomes¹

2013

J Endocrinol Metab

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Ectopic production of adrenocorticotropic hormone by carcinoid tumours is uncommon and covert and occult presentations often hamper its diagnosis. A 27-year-old man was admitted with multiple vertebral bodies collapse related to osteoporosis along with other clinical features consistent with Cushing's syndrome. Both basal and dynamic laboratory evaluation suggested adrenocorticotropicdependent Cushing's syndrome diagnosis, specifically ectopic adrenocorticotropic syndrome. Laboratory testing also showed high serum levels of chromogranin A and urinary 5 hydroxyindoleacetic acid. Pituitary and thoracic-abdominal-pelvic imaging proved to be normal, including the octreoscan. To reduce cortisol levels, and before resorting to adrenalectomy, metyrapone was prescribed but eucortisolism was not achieved. Octreotide therapy reduced plasma adrenocorticotropic hormone and cortisoluria to half although the octreoscan had been negative. As no primitive tumour had been detected, the patient underwent bilateral adrenalectomy. Two years and a half after the diagnosis, an octreoscan detected a lung tumour, which was resected. Pathological analysis revealed an atypical carcinoid tumour and immunohistochemistry was positive for adrenocorticotropic hormone but negative for corticotropin-releasing hormone and chromogranin A. Clinical and biochemical resolution of Cushing' syndrome followed but chromogranin A levels remained above normal. This case highlights both that, although rare, an exuberant osteoporosis can be the initial presentation of ectopic adrenocorticotropic hormone syndrome and high chromogranin A levels may have other origin than direct tumour production. It also raises the question of prescribing somatostatin agonists in patients whose octreoscan is negative as small tumours may produce false negative results. Moreover, the reduction of hypercortisolism before surgery may improve the surgical outcome and with bilateral adrenalectomy may contribute to the primary tumour growth and detection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…The incidence of CS in lung carcinoid tumours is about 1% [10]. Conversely, the incidence of lung carcinoid tumours as the cause of CS remains variable in the literature [10].…”

Section: Discussionmentioning

confidence: 99%

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Pitfalls in the Diagnosis of Ectopic Adrenocorticotropic Hormone Syndrome: A Case Report

Gomes¹

2013

J Endocrinol Metab

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“…Due to the rarity of the syndrome, most clinical reports in the medical literature present a single case or a limited number of cases, and there are few papers specifically reviewing clinical and laboratory data in a large number of patients suffering from ECS secondary to lung tumours [10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Ektopowy zespół Cushinga u pacjentów z nowotworem śródpiersia lub płuc — doniesienie z ośrodka trzeciego stopnia referencyjności w Iranie

Ghazi

Dezfooli

Amirbaigloo

et al. 2015

Endokrynologia Polska

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Introduction: Ectopic Cushing`s syndrome (ECS) secondary to neuroendocrine tumours (NETs) of the lung and mediastinum are rarely encountered. In this study, we present our experience in Iran on 15 patients with ECS secondary to lung and mediastinal tumours over a period of 27 years. Material and methods: Since 1985, 15 patients with ECS secondary to lung and mediastinal tumours have been diagnosed and prospectively followed by the endocrinology team of Taleghani Hospital, Tehran, Iran. The clinical signs and symptoms, laboratory findings, radiological features, immunohistochemical characteristics, management strategies and outcome data are here presented. Results: There were six women and nine men, aged 26-70 years, all presenting with typical features of Cushing's syndrome. Based on histopathologic evaluations, four patients had small cell lung cancer (SCLC) and seven patients had pulmonary NETs, one patient had a thymic NET, and one case was diagnosed as a lung tumourlet. The mean ± SD serum cortisol, 24h urine free cortisol and plasma ACTH were 47.2 ± 20.5 µg/dL, 2,702 ± 5,439 µg/day, and 220 ± 147 pg/mL, respectively. Pulmonary lesions ranged in diameter from 1.1 to 4 cm (mean 1.9 ± 1.1 cm). One patient had a 10 cm mediastinal mass. The duration of follow up in these cases was between one month and seven years (mean 29.9 ± 27.5 months). The four patients with SCLC died within three months of diagnosis. Conclusion: Our data demonstrates the protean clinical and laboratory manifestations of ECS secondary to lung and mediastinal tumours, the problems encountered in diagnosis, and the need for a multidisciplinary approach. This study confirms other series from Western Europe and North America that, unlike the SCLC patients who show a poor outlook, ECS secondary to lung carcinoids has a more favourable prognosis. (Endokrynol Pol 2015; 66 (1): 2-9)

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Cushing's syndrome and nocardiosis associated with a pulmonary carcinoid tumor: Report of a case and review of the literature

Sutton

Parks

Manavi

et al. 2010

Diagnostic Cytopathology

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Ectopic hormone production is an uncommon complication of neoplastic lung disease. Rarely, patients may present with signs and symptoms of systemic endocrine dysfunction related to a hormone-secreting tumor. Bronchopulmonary carcinoids are the most common neoplasm implicated in ectopic ACTH-dependent Cushing's syndrome. Persistent hypercortisolism, such as that which occurs in Cushing's syndrome, causes immunosuppression and makes patients vulnerable to opportunistic infections. We present a case of a 42-year-old woman diagnosed with ACTH-dependent Cushing's syndrome which was originally thought to stem from a pituitary lesion as interpreted on magnetic resonance imaging. Her symptoms persisted after undergoing hypophysectomy, and further work-up involving a fine needle aspiration of the left lung revealed an ACTH-producing carcinoid tumor. Before treatment could be administered, the patient developed several new suspicious nodules in the left lung that were shown by fine needle aspiration to be infectious in nature. A Gram stain revealed numerous Gram positive branching organisms, and culture of the specimen grew Nocardia asteroides. Her pulmonary infection was treated with antibiotics and she underwent successful ablation of the carcinoid tumor.

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Cushing's syndrome secondary to bronchopulmonary carcinoid tumor: Report of two cases and literature review

Cited by 25 publications

References 34 publications

Pitfalls in the Diagnosis of Ectopic Adrenocorticotropic Hormone Syndrome: A Case Report

Pitfalls in the Diagnosis of Ectopic Adrenocorticotropic Hormone Syndrome: A Case Report

Ektopowy zespół Cushinga u pacjentów z nowotworem śródpiersia lub płuc — doniesienie z ośrodka trzeciego stopnia referencyjności w Iranie

Cushing's syndrome and nocardiosis associated with a pulmonary carcinoid tumor: Report of a case and review of the literature

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