title: A case of ectopic ACTH syndrome treated with intermittent administration of dopamine agonists.
abstract: ACTH-dependent Cushing's syndrome includes Cushing's disease and ectopic ACTH syndrome (EAS). The differential diagnosis of Cushing's disease from EAS in cases of ACTH-dependent Cushing's syndrome is a challenging problem. We report here a case of EAS with an unknown source of ACTH secretion. Extensive imaging procedures, involving computed tomography (neck to pelvis), pituitary magnetic resonance imaging, and whole-body (18)F-fluorodeoxyglucose-positron emission tomography, failed to reveal the source of ACTH secretion. Intermittent administration of bromocriptine, a short-acting and nonselective dopamine agonist, has afforded adequate suppression of plasma ACTH and cortisol levels over the long term.
  
  
  CONCLUSIONS
  Tumor excision is the primary treatment for EAS. However, when surgery is impossible, medical therapy is needed to treat hypercortisolism.In cases where the source of ACTH secretion is unknown, inhibitors of steroidogenesis, such as metyrapone, mitotane, ketoconazole, and etomidate, are mostly used to suppress cortisol secretion.Medications that suppress ACTH secretion are less effective, therefore less popular, as standard treatments.In the present case, short-term treatment with dopamine agonists was effective for the long-term suppression of both ACTH and cortisol levels.
authors.affiliation: Department of Endocrinology and Metabolism Hirosaki University Graduate School of Medicine 5 Zaifu-cho, Hirosaki, Aomori, 036-8562 Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Sakihara
authors.affiliation: Department of Endocrinology and Metabolism Hirosaki University Graduate School of Medicine 5 Zaifu-cho, Hirosaki, Aomori, 036-8562 Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Kageyama
authors.affiliation: Department of Endocrinology and Metabolism Hirosaki University Graduate School of Medicine 5 Zaifu-cho, Hirosaki, Aomori, 036-8562 Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamagata
authors.affiliation: Department of Endocrinology and Metabolism Hirosaki University Graduate School of Medicine 5 Zaifu-cho, Hirosaki, Aomori, 036-8562 Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Terui
authors.affiliation: Department of Endocrinology and Metabolism Hirosaki University Graduate School of Medicine 5 Zaifu-cho, Hirosaki, Aomori, 036-8562 Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Daimon
authors.affiliation: Department of Endocrinology and Metabolism Hirosaki University Graduate School of Medicine 5 Zaifu-cho, Hirosaki, Aomori, 036-8562 Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Suda