ECE2017 Eposter Presentations: Adrenal and Neuroendocrine Tumours Adrenal cortex (to include Cushing's) (86 abstracts)
Paraneoplastic Cushing’s syndrome and nephrotic syndrome in a patient with bronchial carcinoid
Daniel Grigorie 1, , Andra Caragheorghopol 2 , Carmen Iordachescu 2 , Dan Hortopan 2 , Ionela Pascanu 3 , Livia Hara 4 , Iulian Brezean 1 , Nicolae Galie 1 , Florina Vasilescu 5 , Eugen Mandache 6 & Alina Sucaliuc 1,
1Carol Davila University of Medicine, Bucharest, Romania; 2National Institute of Endocrinology, Bucharest, Romania; 3University of Medicine, Targu Mures, Romania; 4Matei Bals Hospital, Bucharest, Romania; 5Central Military Hospital, Bucharest, Romania; 6Carol Davila Nephrology Hospital, Bucharest, Romania.
Introduction: We report a case of Cushing’s syndrome association with nephrotic syndrome in a patient with occult ectopic ACTH (EAS) secretion by a bronchial carcinoid and resolution of both disorders after bilateral adrenalectomy.
Case report: A 42-year-old man was admitted to our department with the suspicion of EAS. He was in a very good health until several months ago when he developed suddenly nephrotic syndrome, severe hypertension, severe hypokalemia, hyperglicemia and rapidly progressive the full blown picture of severe hypercortisolism: severe mental changes, muscle weakness, bruising, pigmented moon facies, no striae, distal muscular atrophy and weight loss. A renal biopsy showed podocyte foot process effacement and no inflammation/sclerosis; renal function was normal. Serum cortisol was frankly elevated and variable (21–97 μg/dl), because of the heavy and variable proteinuria (1.7–7.5 g/24 h), urinary free cortisol 37.071 nmol/24 h. Serum cortisol did not supress with both low -dose and high-dose dexamethasone and serum ACTH was high (238 pg/ml). A pituitary MRI was normal. Chest CT scan revealed a round subpleural nodule 8–9 mm in the right lung. SRS (111-indium-pentetreotide) and 18-FDG-PET CT scans were negative. Bilateral laparoscopic adrenalectomy was performed. Postoperative course was marked by sepsis and he was treated with antibiotics for three months. All the sign and symptoms of hypercortisolism gradually disappeared but the pigmentation remained; surprisingly the resolution of the nephrotic syndrome was noted. One year later he was in good clinical condition with adrenal replacement therapy. Chest CT scan confirmed the presence of a stable pulmonary nodule and he underwent thoracic surgery. A bronchial typical carcinoid tumour with positive immunostaining for ACTH was diagnosed. Postoperative course was uneventful.
Conclusion: This is a rare case of the association of severe occult EAS with nephrotic syndrome, which has been cured by the resolution of the severe hypercortisolism.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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