| Popis: |
Background: Cushing’s syndrome (CS) is characterized by the overproduction of cortisol. Common causes include pituitary adenomas and excess produceduction from adrenal pathologies. Rarely pulmonaryneuroendocrine tumors can produce ACTH and cause CS. It is controversial if such tumors are more aggressive. Case Report: A 45years old male hospitalized due to weakness, dyspnea, swelling of ankles, disorientation and raised levels of Cortisol (>60.0 mcg/dL), Parathormone (168 ng/L), low level of Aldosterone (0.4 mcg/24H) and severe hypokalemia (1.8 mEg/L). MRI of the pituitary gland and brain with contrast did not show any abnormalities. CT- scan of the thorax and abdomen showed a lesion in the right lower lobe with size 1.7 cm. After potassium substitution and improvement the patient was discharged and redirected to Endocrinology, where additional findings were raised levels of ACTH (155.7 pg/ml), Chromogranin A (116 ng/ml) and urinary free Cortisol (1750 nmol/24h). SPECT-CT with99mTc-Tektrotyd showed high tracer accumulation in the lung lesion and the adrenal glands. The fibrobronchoscopy showed normal endoscopic finding. The patient was admitted underwent right pyramid resection and mediastinal lymph node dissection. The histology was typical carcinoid - T1bN0M0- st. After the removal of the tumor all hormonal levels normalized. In the next 6 months of follow up the patient is in very good condition with normal hormonal levels. Conclusion: Ectopic ACTH- secreting tumours are some of the most challenging differential diagnoses and require multidisciplinary approach with close collaboration between endocrinologist, surgeon, pathologist, and radiologist. |
