Reduction of a Pancreatic Tumor after Total Removal of an ACTH Secreting Pituitary Tumor: Differential Diagnosis of Cushing's Syndrome

Abstract

Abstract. Endocrinologic tests sometimes fail to distinguish adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma from ectopic ACTH-secreting tumor. The authors experienced a case of Cushing's disease associated with a pancreatic tumor. Venous sampling contributed to the final diagnosis of Cushing's disease in this complex case, while endocrinologic tests showed paradoxical results. A 54-year-old woman presented with Cushing's syndrome and pancreatic tumor. Magnetic resonance imaging (MRI) failed to reveal a pituitary tumor, but a gadolinium-enhanced tumor with cystic components was seen in the pancreatic tail. Results of conventional endocrinologic tests suggested ectopic ACTH syndrome, but venous sampling including cavernous sinus sampling indicated an ACTH-secreting pituitary adenoma. Transsphenoidal surgery revealed a pituitary microadenoma, and total removal of the tumor was achieved. Postoperative abdominal MRI revealed that the pancreatic tumor diminished gradually without treatment. Selective cavernous sinus sampling was useful for distinguishing ACTH-secreting pituitary adenoma from ectopic ACTH syndrome in this complex case. This was a rare case in which the pancreatic tumor diminished after total removal of the ACTHsecreting pituitary adenoma.

Altered FDG uptake patterns in pediatric lymphoblastic lymphoma patients receiving induction chemotherapy that includes very high dose corticosteroids

“…Previous publications describing FDG PET or PET/CT scans in Cushingoid patients with ACTH-secreting tumors or adrenal hyperplasia have not reported altered FDG uptake patterns [18][19][20][21][22][23][24][25][26]. Our study is limited by the lack of a control population and the small number of children.…”

A ‘smart’ type of Cushing's syndrome

“…A different classification is based on the difference between Cushing's syndrome and Cushing's disease. Furthermore, ectopic adrenocorticotrophin hormone (ACTH) production is also a well-known cause of Cushing's syndrome (2)(3)(4)(5)(6). Less frequent causes are food-induced Cushing's syndrome (7,8), alcohol-induced pseudo-Cushing's syndrome (2,9), depression and obesity (2).…”