title: Use of adrenal arterial embolization in severe ACTH-dependent Cushing's syndrome.
abstract: The management of a patient with severe Cushing's syndrome due to ectopic ACTH produced by a medullary carcinoma of the thyroid is described. Initial treatment with maximal adrenolytic medical therapy and two attempts at bilateral adrenal venous infarction had failed to control the disease, and she was at that time unfit for surgery. Subsequent use of bilateral adrenal arterial embolization enabled medical therapy to produce sufficient control of the Cushing's syndrome to allow bilateral adrenalectomy to be performed successfully, with resultant cure of the excessive cortisol production.
authors.affiliation: Department of Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK.
authors.forename: S B
authors.initials: SB
authors.lastname: Blunt
authors.forename: M
authors.initials: M
authors.lastname: Pirmohamed
authors.forename: V K
authors.initials: VK
authors.lastname: Chatterjee
authors.forename: J M
authors.initials: JM
authors.lastname: Burrin
authors.forename: D J
authors.initials: DJ
authors.lastname: Allison
authors.forename: G F
authors.initials: GF
authors.lastname: Joplin
mesh_terms: D000182:ACTH Syndrome, Ectopic / Q000150:complications*; D000311:Adrenal Glands / Q000098:blood supply*; D002277:Carcinoma / Q000378:metabolism*; D003131:Combined Modality Therapy; D003480:Cushing Syndrome / Q000209:etiology / Q000628:therapy*; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008797:Metyrapone / Q000627:therapeutic use; D008875:Middle Aged; D009384:Paraneoplastic Endocrine Syndromes / Q000150:complications*; D013964:Thyroid Neoplasms / Q000378:metabolism*
chemical_list: D008797:Metyrapone