Occult ectopic ACTH secretion due to recurrent lung carcinoid: long-term control of hypercortisolism by continuous subcutaneous infusion of octreotide.
We report on a woman with clinical Cushing's syndrome confirmed by biochemical data. The Cushing's syndrome was shown to be ACTH dependent and inferior petrosal sinus sampling pointed to an ectopic source. After resection of a lung carcinoid a well documented remission of Cushing's syndrome was obtained. At recurrence of Cushing's syndrome 18 months later the ACTH source could not be located despite extensive diagnostic procedures. Clinical and biochemical control of hypercortisolism was achieved by continuous subcutaneous infusion of octreotide. During a brief interruption of treatment recurrence of clinical and biochemical signs and symptoms of Cushing's syndrome were demonstrated. We conclude that in this case of occult ectopic ACTH secretion, presumably due to recurrent lung carcinoid, continuous subcutaneous infusion therapy with octreotide resulted in clinical and metabolic control of Cushing's syndrome for 8 years. In addition excellent tumour growth control was achieved as repeated searches for tumour recurrence or metastasis remained negative.
Van den Bruel
A
A
Laboratory and Clinic of Experimental Medicine and Endocrinology, Universitaire Ziekenhuizen Gasthuisberg, Leuven.
Bex
M
M
Van Dorpe
J
J
Heyns
W
W
Bouillon
R
R
D000182:ACTH Syndrome, Ectopic / Q000188:drug therapy* / Q000209:etiology; D000328:Adult; D002276:Carcinoid Tumor / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006728:Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007260:Infusion Pumps; D008175:Lung Neoplasms / Q000150:complications*; D009364:Neoplasm Recurrence, Local / Q000150:complications*; D015282:Octreotide / Q000008:administration & dosage* / Q000627:therapeutic use; D013004:Somatostatin / Q000031:analogs & derivatives*
D006728:Hormones; D013004:Somatostatin; D015282:Octreotide