title: A challenging case of an ectopic cushing syndrome.
abstract: Bronchopulmonary carcinoids are rare pulmonary neoplasms although they account for most cases of ectopic ACTH syndromes. When feasible, the mainstay treatment is surgical resection of the tumor. We report the case of a 52-year-old woman with signs and symptoms suggestive of hypercortisolism for 12 months, admitted to our department because of community acquired pneumonia. Blood hormone analysis showed increased levels of ACTH and urinary free cortisol and nonsuppressibility to high- and low-dose dexamethasone tests. Pituitary MRI showed no lesion and no central-to-peripheral ACTH gradient was present in bilateral inferior petrosal sinus sampling. CRH stimulation test suggested an ectopic ACTH source. Thoracic CT scan revealed a nodular region measuring 12 mm located in the inferior lingular lobule of the left superior lung with negative uptake by (18)-FDG-PET scan and negative SRS. The patient was successfully treated with an atypical lung resection and histology revealed an atypical bronchial carcinoid tumor with positive ACTH immunoreactivity. This was an interesting case because the patient was admitted due to pneumonia that may have been associated with her untreated and chronic hypercortisolism and a challenging case of ectopic ACTH syndrome due to conflicting results on the diagnostic exams.
authors.affiliation: Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar São João, Rua Alberto Serpa No. 150/152, 4100-010 Porto, Portugal.
authors.forename: Joana
authors.initials: J
authors.lastname: Menezes Nunes
authors.affiliation: Faculty of Medicine, Porto University, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal.
authors.forename: Elika
authors.identifier: 0000-0001-6883-6742
authors.initials: E
authors.lastname: Pinho
authors.affiliation: Faculty of Medicine, Porto University, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal ; Internal Medicine Department, Centro Hospitalar São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal.
authors.forename: Isabel
authors.initials: I
authors.lastname: Camões
authors.affiliation: Cardiothoracic Surgery Department, Centro Hospitalar São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Maciel
authors.affiliation: Cardiothoracic Surgery Department, Centro Hospitalar São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Cabral Bastos
authors.affiliation: Faculty of Medicine, Porto University, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal ; Pathology Department, Centro Hospitalar S. João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal.
authors.forename: Conceição
authors.initials: C
authors.lastname: Souto de Moura
authors.affiliation: Faculty of Medicine, Porto University, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal ; Cardiothoracic Surgery Department, Centro Hospitalar São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Bettencourt