Multiple Pulmonary Nodules in Ectopic Adrenocorticotropic Hormone Syndrome: Cause or Result?

Chang, Shan-Yueh; Huang, Tseng; Su, Wen‐Lin; Chian, Chih-Feng; Perng, Wann-Cherng

doi:10.1159/000335129

Cited by 6 publications

(3 citation statements)

References 19 publications

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“…It was reported that the tumors could not be found with a CT scan or an MRI in about 20-50% of the EAS cases (2). The outcomes after lung surgery for suspected tumors were sometimes unsatisfactory, because in these cases the resected nodules were not the ectopic ACTH secreting tumors, but were the results of opportunistic infections, such as invasive pulmonary aspergillosis or bacillosis due to hypercortisolism (5,6). In our cases, four patients could not recover after lobectomy or excision of the mediastinal tumor.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of ectopic adrenocorticotropic hormone syndrome with intra-thoracic tumor

et al. 2016

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The thoracic cavity should be a focus in routine examinations of patients with symptoms of Cushing's syndrome (CS), because ectopic ACTH-producing tumors are commonly found in bronchus/lung and mediastinum. Despite the incidence of the pulmonary nodule secondary to opportunistic infection in some cases, surgery is still the first choice if the tumor is localized. The surgical procedure should be performed according to the principles in resection of lung cancer and mediastinal tumor. The surgical efficacy is significant for short-term periods; however, the recurrence of the disease in long-term periods is in great part related to distal metastasis or relapse of the tumor.

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Section: Discussionmentioning

confidence: 99%

Surgical treatment of ectopic adrenocorticotropic hormone syndrome with intra-thoracic tumor

et al. 2016

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“…Indeterminate lesions are still one of the most challenging problems in current clinical practice. In such cases, computerized tomography (CT) serves as the standard of reference and its use is recommended for the evaluation of these nodules in the current guidelines [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. Although magnetic resonance imaging (MRI) is not used as a first choice in the evaluation of indeterminate nodules, the advantages of using dynamic MRI for tumor catheterization have been demonstrated in several studies [ 9 , 10 ], and due to technical improvements MRI has gained importance for tumor detection and interpretation [ 11 , 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

The Role of Dynamic Magnetic Resonance Imaging in the Evaluation of Pulmonary Nodules and Masses

et al. 2012

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Objective: The aim of our study was to determine whether or not dynamic magnetic resonance imaging (MRI) with kinetic and morphological parameters can reveal significant differences between malignant and benign pulmonary lesions, and thus to evaluate the use of dynamic MRI in the management of pulmonary nodules. Patients and Methods: Thirty-one patients (4 women and 27 men) underwent 1.5 T MRI, where 10 consecutive dynamic series were performed every 30 s by using 3D fast low-angle shot sequences. The percentage increase in the signal intensity of the lesions was determined for each time point. Time-enhancement curves of the lesions were drawn and classified into four types: A, B, C and D. Early peak (EP) and maximum peak (MP) values of the curves were calculated and compared with the diagnoses of the patients. The usefulness of these parameters was tested statistically. In addition to the comparison of the parameters between the groups, receiver-operating characteristic analysis was used to assess sensitivity, specificity, and both positive and negative predictive values of EP and MP parameters. Results: Of the 31 pulmonary lesions, 16 (52%) were malignant. These showed a stronger enhancement with higher median values of EP and MP (77.08 and 123.15, respectively) than those corresponding to the benign lesions (14.45 and 32.53, respectively). There were significant differences between the benign and malignant lesions (p < 0.001). Sensitivity, specificity, positive predictive value and negative predictive value were 75, 93, 92 and 78% for EP and 93, 86, 88 and 93% for MP, respectively. Conclusion: A combination of kinetic and morphological evaluation in dynamic MRI provided accurate differentiation between benign and malignant pulmonary lesions. It was a useful and noninvasive method of evaluating pulmonary nodules.

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“…Although, PJP was mainly described in patients with extreme UFC elevations (> 20 × ULN), it could also manifest with less severe hypercortisolemia (125). Cortisol lowering treatment typically triggers PJP development within a few days (134,135,136), though infection may occur before treatment in severe CS (137,138). For comparison, in patients on GC treatment, median time to immune reconstitution after end of GC therapy is 8 days for fungal and 21-42 days for viral infection (139).…”

Section: Infection Risk Factorsmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Cardiovascular risk assessment, thromboembolism, and infection prevention in Cushing’s syndrome: a practical approach

Varlamov

Langlois

Vila

et al. 2021

European Journal of Endocrinology

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Cushing’s syndrome (CS) is associated with increased mortality that is driven by cardiovascular, thromboembolic, and infection complications. Although complications can be expected to decrease during disease remission, incidence often transiently increases postoperatively and is not completely normalized in the long-term. It is important to diagnose and treat cardiovascular, thromboembolic, and infection complications concomitantly with CS treatment. Management of hyperglycemia/diabetes, hypertension, hypokalemia, hyperlipidemia, and other cardiovascular risk factors is generally undertaken in accordance with standard of clinical care. Medical therapy for CS may be needed even prior to surgery in severe and/or prolonged hypercortisolism, and treatment adjustments can be made based on disease pathophysiology and drug-drug interactions. Thromboprophylaxis should be considered for CS patients with severe hypercortisolism and/or postoperatively, based on individual risk factors of thromboembolism and bleeding. Pneumocystis jiroveci pneumonia prophylaxis should be considered for patients with high urinary free cortisol at initiation of hypercortisolism treatment.

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Multiple Pulmonary Nodules in Ectopic Adrenocorticotropic Hormone Syndrome: Cause or Result?

Cited by 6 publications

References 19 publications

Surgical treatment of ectopic adrenocorticotropic hormone syndrome with intra-thoracic tumor

Surgical treatment of ectopic adrenocorticotropic hormone syndrome with intra-thoracic tumor

The Role of Dynamic Magnetic Resonance Imaging in the Evaluation of Pulmonary Nodules and Masses

MANAGEMENT OF ENDOCRINE DISEASE: Cardiovascular risk assessment, thromboembolism, and infection prevention in Cushing’s syndrome: a practical approach

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