Endocrine Abstracts

A 55-year-old lady was referred by her GP to the acute medical unit with a 4-week history of fatigue, generalised swelling and weight gain of a stone, together with a potassium 2.8 mmol/l and sodium 146 mmol/l. Her blood pressure was 211/85 mmHg and she was suspected of having Conn’s syndrome. Treatment was started with Amlodipine 5 mg daily and Spironolactone 25 mg daily which was increased to 100 mg daily on subsequent follow-up in the acute medical unit. She remained unwell despite correction of her hypokalaemia and blood pressure and an aldosterone of 66 pmol/l ruled out Conn’s. She was discussed with the endocrine team who noticed she had some difficulty getting up from her chair and that she looked cushingoid. Although she had never smoked and had no chest symptoms a chest X-ray was requested which showed a 35 mm opacity in the right middle lobe which was confirmed with a CT scan. 24-h urine cortisol was 11208 nmol/l, random cortisol was >1750 nmol/l and ACTH 262 ng/l, compatible with ectopic ACTH syndrome. She was started on Metyrapone 250 mg qds, increasing to 500 mg qds. At bronchoscopy a vascular lesion was seen suggesting a possible bronchial carcinoid. Bronchial washings were unhelpful. A PET scan showed a metabolically active 3.7 cm mass with SUV max of 4.9. There was also mild metabolic activity in both adrenal glands. A right middle lobectomy was performed and histology confirmed a typical carcinoid tumour. Subsequently after a 1 mg overnight dexamethasone suppression test her cortisol was 24 nmol/l and she made a complete recovery no longer requiring antihypertensive medication.