[Octreotide + bilateral adrenalectomy in the management of ACTH-producing carcinoid tumors].
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.
Czepielewski
Mauro A
MA
Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, UFRGS. maurocze@terra.com.br
Colli
Maikel
M
Harlos
Tatiana
T
Silveiro
Sandra Pinho
SP
Maraschin
Jorge
J
Copette
Fabio
F
Leitão
Cristiane B
CB
Rollin
Guilherme A F S
GA
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
D018931:Antineoplastic Agents, Hormonal; D009363:Neoplasm Proteins; D000324:Adrenocorticotropic Hormone; D015282:Octreotide