title: Thallium-201 scintigraphy was useful in diagnosing ectopic ACTH syndrome due to bronchial carcinoid.
abstract: Abstract. Initial investigations of a 70-year-old woman with clinical Cushing's syndrome, including overnight dexamethasone suppression test, CRH test, and pituitary MRI, suggested the presence of ectopic ACTH production. Thoracic computed tomography (CT) scan revealed a mass measuring 7 mm in the right lung, but it was thought to be an incidental opacity, leaving the source of ectopic ACTH undetermined for several years. During this period, although the size of the lung opacity did not change remarkably, serum cortisol levels became elevated to 43 microg/dl, and the patient's symptoms worsened. Tl-201 SPECT demonstrated intense accumulation in the right lung. The mass was surgically resected using thoracoscopy to investigate it as the focus of ACTH production. Histological and immunohistochemical examination confirmed that the area of intense Tl-201 uptake was an ACTH-producing bronchial carcinoid. Plasma ACTH and cortisol levels decreased immediately after the surgery. In conclusion, this case demonstrated Tl-201 scintigraphy as a useful tool in identifying the location of an ACTH-producing bronchial carcinoid.
authors.affiliation: Department of Medicine II, Tokyo Women's Medical University, Japan.
authors.forename: E
authors.initials: E
authors.lastname: Itoh
authors.forename: I
authors.initials: I
authors.lastname: Fukuda
authors.forename: A
authors.initials: A
authors.lastname: Sata
authors.forename: M
authors.initials: M
authors.lastname: Kanazawa
authors.forename: T
authors.initials: T
authors.lastname: Ohnuki
authors.forename: N
authors.initials: N
authors.lastname: Hizuka
authors.forename: K
authors.initials: K
authors.lastname: Kusakabe
authors.forename: K
authors.initials: K
authors.lastname: Takano
mesh_terms: D000182:ACTH Syndrome, Ectopic / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D000368:Aged; D001984:Bronchial Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000378:metabolism; D005260:Female; D006801:Humans; D011877:Radionuclide Imaging / Q000379:methods; D013794:Thallium Radioisotopes
chemical_list: D013794:Thallium Radioisotopes