A rare case of Cushing syndrome by cyclic ectopic-ACTH.
ACTH-dependent Cushing syndrome (CS) due to ectopic ACTH production is most times difficult to manage. The identification of the source of ACTH may take many years. Surgery or chemotherapy for the primary tumor is not always possible. Control of Cushing symptoms is many times achieved using medication, or bilateral adrenalectomy in refractory cases. This case presents a Brazilian male who showed severe hypertension, mood changes, muscle weakness, darkening of skin, and increased abdominal fat. An investigation for Cushing syndrome was carried out and, after a four-year follow-up, a carotid glomus tumor (chemodectoma) was confirmed, a rare ectopic ACTH-producing tumor. Besides, the patient presented cyclic Cushing syndrome that was exacerbated by diverticulitis episodes. This case presents interesting pitfalls on diagnosis and management of ACTH-dependent CS. This is the only report of a chemodectoma that produced ACTH in the literature.
Serviço de Metabologia, Instituto Estadual de Diabetes e Endocrinologia, Rio de Janeiro, Brazil.
Mariana
M
Farage
Mario Alberto da Dantas Loures
MA
Costa
Amélio Fernando
AF
Godoy-Matos
D000182:ACTH Syndrome, Ectopic / Q000150:complications / Q000175:diagnosis*; D000324:Adrenocorticotropic Hormone / Q000378:metabolism*; D002345:Carotid Body Tumor / Q000150:complications / Q000175:diagnosis*; D003480:Cushing Syndrome / Q000175:diagnosis* / Q000209:etiology; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008875:Middle Aged; D010236:Paraganglioma, Extra-Adrenal / Q000150:complications / Q000175:diagnosis*
D000324:Adrenocorticotropic Hormone