Endocrine Abstracts

Introduction: Despite advances in analytic and imaging techniques, the syndrome of ectopic ACTH secretion from a tumour resulting in Cushing’s syndrome continues to pose difficult diagnostic and therapeutic challenges. We report a patient with ectopic ACTH from a bronchial carcinoid tumour highlighting the unusual presentation and difficulties in management.

Case description: A 23-year-old man with a past medical history of Cushing disease presented with typical Cushingoid appearance which had become apparent for about a year prior to presentation. He had hypokalemia, metabolic alkalosis, hypertension, osteoporosis and weight gain. Following thoracotomy and resection of his lung lesion, the plasma ACTH decreased significantly. When reviewed in clinic 12 months after surgery, he was symptomatically well, with good lung function.

Conclusion: Ectopic ACTH-secreting tumours present some of the most challenging differential diagnoses in endocrinology and require careful clinical, biochemical, radiological, and pathological investigation.