title: Cushing's syndrome due to ectopic adrenocorticotropic hormone production secondary to hepatic carcinoid: diagnosis, treatment, and improved quality of life.
abstract: BACKGROUND
  We describe a previously healthy 40-year-old woman with Cushing's syndrome caused by adrenocorticotropic hormone (ACTH) secretion from metastatic carcinoid.
  
  
  METHODS
  Over a 2-year period, the patient had multiple hospitalizations for uncontrolled hypertension, hyperglycemia, and hypokalemia. She had transient flushing, rashes, and a rapid weight gain. In addition, she developed anasarca and had a nontraumatic hip fracture 1 month before presentation. Subsequently, a hypertensive crisis resulted in admission to the intensive care unit and fine-needle aspiration of a liver lesion.
  
  
  CONCLUSIONS
  A diagnosis of metastatic carcinoid was established. She was transferred to our hospital for further evaluation and management. On arrival, she had the signs of Cushing's syndrome. Despite extensive evaluation, her primary carcinoid tumor was not localized. She was treated successfully with bilateral adrenalectomy and octreotide.
  
  
  CONCLUSIONS
  This case illustrates how early recognition of the signs and symptoms of excess ACTH is important for prompt and appropriate treatment.
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, USA.
authors.forename: Susan G
authors.initials: SG
authors.lastname: Coe
authors.forename: Winston W
authors.initials: WW
authors.lastname: Tan
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Fox
mesh_terms: D000182:ACTH Syndrome, Ectopic / Q000209:etiology*; D000315:Adrenalectomy; D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D044963:Biopsy, Fine-Needle; D002276:Carcinoid Tumor / Q000378:metabolism* / Q000556:secondary; D003480:Cushing Syndrome / Q000209:etiology* / Q000601:surgery; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000378:metabolism* / Q000556:secondary; D008303:Malignant Carcinoid Syndrome / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D015282:Octreotide / Q000627:therapeutic use; D011788:Quality of Life
chemical_list: D018931:Antineoplastic Agents, Hormonal; D015282:Octreotide