Diagnosis of lung carcinoid with cutaneous hyperpigmentation eight years after bilateral adrenalectomy.
A 26-yr-old male was submitted to bilateral adrenalectomy in 1977 for Cushing's syndrome. Some months later he developed intense skin hyperpigmentation together with increased ACTH levels (149 to 4000 ng/l). The sellar region was always normal in X-ray studies. In April 1985, when the patient complained of chest pain, a chest x-ray showed a polycyclic mass in the upper left lobe of the lung. ACTH ranged from 20,000 to 100,000 ng/l, with no response to CRF or cyproheptadine administration. Urinary 5-OH-indolacetic acid was negative. Thoracotomy was performed in July 1985 with resection of two intrapulmonary masses. Histologic study demonstrated a carcinoid tumor, with positive neuron-specific enolase and ACTH immunochemical stain. ACTH concentration in tumoral tissue was 91 pg/g tissue. After surgery ACTH fell dramatically to 37 ng/l, and has remained at this level since then, associated with resolution of the skin hyperpigmentation.
Rodriguez Vaca
M D
MD
Endocrinology and Diabetes Unit, Hospital Clinic, School of Medicine, Barcelona, Spain.
Angel
M
M
Halperin
I
I
Freixenet
J
J
Marti
M
M
Martinez Osaba
M J
MJ
Sanchez Lloret
J
J
Palacin
A
A
Vilardell
E
E
D000315:Adrenalectomy / Q000009:adverse effects*; D000324:Adrenocorticotropic Hormone; D000328:Adult; D002276:Carcinoid Tumor / Q000150:complications / Q000175:diagnosis*; D003480:Cushing Syndrome / Q000601:surgery*; D006801:Humans; D007150:Immunohistochemistry; D008175:Lung Neoplasms / Q000150:complications / Q000175:diagnosis*; D008297:Male; D010859:Pigmentation Disorders / Q000150:complications / Q000209:etiology*
D000324:Adrenocorticotropic Hormone