Endocrine Abstracts

Introduction: Rapid deterioration of health condition in patient with diagnosed neoplastic disease, especially metastatic one, requires consideration of cancer progression. However other rare severe complications can occur. In 0.6–0.7% patients with medullary thyroid cancer (MTC) the ectopic ACTH syndrome (EAS) is observed. Hereby, we present a case EAS in patient suffered from MTC.

Case report: A 37-year-old man was admitted to the Department of Internal Medicine in serious clinical condition with general fatigue and chest pain. Myocardial infarction has been excluded. Patient’s past medical history was remarkable for MTC with numerous reoperations. Routine laboratory test showed de novo diabetes mellitus. Calcitonin serum level was 499.53 pg/ml (n: 0–10 pg/ml). Additional tests revealed severe hypercortisolaemia (cortisol level 2100 nmol/l; n: 0700–1000 h: 171–536 nmol/l). The patient was referred to the Department of Endocrinology for further diagnostics and treatment. ACTH level was 329.0 pg/ml (n<60.0). There was no suppression of cortisol secretion after 1 mg of dexamethasone. Magnetic resonance imaging (MRI) of the pituitary gland showed no signs of macro or microadenoma. Computer tomography (CT) of the chest revealed metastasis to the mediastinum lymph nodes. The adrenal glands in CT were normal size and shape. The EAS was diagnosed. Owing to the rapid deterioration of general condition despite of ketoconazole treatment, bilateral adrenalectomy was performed. The patient in severe condition was transferred to the Intensive Care Unit. Four reoperations were conducted due to the: internal bleeding, megacolon toxicum, faecal peritonitis and eventration. On the 41th day after first surgery the patient died due to sepsis.

Conclusions: The EAS is a rare condition in patients with MTC, but our patient’s history should serve as a warning to actively seek of EAS in case of metastatic disease, especially in rapid health deterioration.