title: Chronic necrotising aspergillosis mimicking ACTH-secreting tumour in a case of Cushing's disease.
abstract: An 18-year-old man presenting with speech and behaviour disorders was found to suffer from Cushing's syndrome. Ectopic ACTH secretion was initially suspected on the basis of very high cortisoluria and ACTH concentrations, severe hypokalemia, a lung hypermetabolic lesion and a normal pituitary on conventional magnetic resonance imaging (MRI). After lung surgery, this lesion proved to be chronic necrotising aspergillosis (CNA). Diagnostic reevaluation by bilateral inferior petrosal sinus sampling disclosed a right-sided petrosal sinus gradient consistent with Cushing's disease (CD). A new high resolution thin-section MRI demonstrated a 5 mm pituitary adenoma, which could be removed successfully. Thus, a lung mass associated with several clues in favour of ectopic ACTH secretion may hide a diagnosis of CD. Such a mass can be CNA, an opportunistic infection favoured by immunosuppression, which to our knowledge, is the first case reported in CD.
authors: Department of Internal Medicine-Endocrinology, University Hospital of Mont-Godinne, Université catholique de Louvain, Yvoir, Belgium.
authors: C
authors: C
authors: Jonas
authors: Ph
authors: P
authors: Eucher
authors: Th
authors: T
authors: Gustin
authors: J E
authors: JE
authors: Donckier
mesh_terms: D000182:ACTH Syndrome, Ectopic / Q000175:diagnosis; D000293:Adolescent; D002908:Chronic Disease; D003937:Diagnosis, Differential; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009336:Necrosis; D017591:Petrosal Sinus Sampling; D047748:Pituitary ACTH Hypersecretion / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery; D055732:Pulmonary Aspergillosis / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery