title: [Octreotide + bilateral adrenalectomy in the management of ACTH-producing carcinoid tumors].
abstract: Cushing's syndrome (CS) due to ectopic ACTH secretion has a high morbidity and mortality. Thus, rapid treatment of ectopic CS is mandatory. Carcinoid tumors associated with ectopic ACTH (CTu-ACTH) syndrome represent a more severe clinical picture, due to the carcinoid symptoms that worsen the hypercortisolism state. Management of patients with CTu-ACTH should include the control of hypercortisolism, as well as the carcinoid disturbance. We report 3 patients (2F, 1M) with CTu-ACTH (2 pancreatic, 1 occult) who presented with clinical manifestations of CS (n= 3) and carcinoid syndrome (2): 2 were initially investigated for CS and 1 carcinoid syndrome. In all hypokalemia, hypertension and diabetes mellitus were associated with severe hypercortisolism and high ACTH levels. Administration of octreotide-LAR reduced ACTH levels from 230,000 to 30,000 pg/ml in patient 1, and controlled symptoms of carcinoid syndrome and neoplasic lesions in patient 2; treatment with subcutaneous octreotide in patient 3 controlled carcinoid syndrome and partially reduced symptoms of hypercortisolism. All 3 patients were submitted to bilateral adrenalectomy to control CS. Our data show that combined anti-neoplastic therapy may contribute to the stabilization and/or definitive control of CTu-ACTH.
authors.affiliation: Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, UFRGS. maurocze@terra.com.br
authors.forename: Mauro A
authors.initials: MA
authors.lastname: Czepielewski
authors.forename: Maikel
authors.initials: M
authors.lastname: Colli
authors.forename: Tatiana
authors.initials: T
authors.lastname: Harlos
authors.forename: Sandra Pinho
authors.initials: SP
authors.lastname: Silveiro
authors.forename: Jorge
authors.initials: J
authors.lastname: Maraschin
authors.forename: Fabio
authors.initials: F
authors.lastname: Copette
authors.forename: Cristiane B
authors.initials: CB
authors.lastname: Leitão
authors.forename: Guilherme A F S
authors.initials: GA
authors.lastname: Rollin
mesh_terms: D000315:Adrenalectomy / Q000379:methods; D000324:Adrenocorticotropic Hormone / Q000378:metabolism*; D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D002276:Carcinoid Tumor / Q000378:metabolism / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000378:metabolism*; D015282:Octreotide / Q000627:therapeutic use*; D010911:Pituitary Neoplasms / Q000378:metabolism / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D009363:Neoplasm Proteins; D000324:Adrenocorticotropic Hormone; D015282:Octreotide