title: [Paraneoplastic Cushing's syndrome, a real diagnostic and therapeutic challenge: A case report and literature review].
abstract: BACKGROUND
  Paraneoplastic Cushing's syndrome is a rare cause of endogenous hypercortisolism attributable to ectopic ACTH secretion by non-pituitary tumors. Imaging and biochemical results are often inconclusive and differential diagnosis with Cushing's disease can then be challenging. Moreover, these tumors may be occult and difficult to find and thus the need of new imaging tools such as (18)FDG-PET scan and (18)DOPA-PET scan.
  
  
  METHODS
  We report a 50-year-old man who presented with very aggressive clinical features related to Cushing's syndrome. Biological work-up confirmed the hypercortisolism and was consistent with an ectopic ACTH secretion. Conventional localization techniques failed to show any tumor and bilateral adrenalectomy was performed because of life-threatening complications. Two years later, thoracic computed tomography reveals an 11 mm mass in the left lower pulmonary lobe, (18)FDG-PET scan found a non-specific mild hypermetabolism of the lung nodule, and the (18)DOPA-PET scan confirmed the high uptake of this nodule suggesting an endocrine carcinoma. Histology confirmed a typical carcinoid tumor. The tumor cells stained positive for ACTH, CD56, chromogranin and synaptophysin.
  
  
  CONCLUSIONS
  This case illustrates the dilemma between the need for morphological diagnosis of the ectopic ACTH source and control of the life-threatening hypercortisolism. (18)FDG-PET scan and (18)DOPA-PET scan should be considered early as a secondary diagnostic tool when conventional imagery fails to show any tumor.
authors.affiliation: Service d'endocrinologie et métabolisme, hôpital militaire d'instruction Mohammed V, Hay Riad, 10100 Rabat, Maroc. Electronic address: dr.azzelarab@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Meftah
authors.affiliation: Service d'endocrinologie et métabolisme, hôpital militaire d'instruction Mohammed V, Hay Riad, 10100 Rabat, Maroc.
authors.forename: A
authors.initials: A
authors.lastname: Moumen
authors.affiliation: Service de chirurgie thoracique, hôpital militaire d'instruction Mohammed V, Hay Riad, 10100 Rabat, Maroc.
authors.forename: M
authors.initials: M
authors.lastname: Massine El Hammoumi
authors.affiliation: Service d'endocrinologie et métabolisme, hôpital militaire d'instruction Mohammed V, Hay Riad, 10100 Rabat, Maroc.
authors.forename: S
authors.initials: S
authors.lastname: Hajhouji
authors.affiliation: Service d'endocrinologie et métabolisme, hôpital militaire d'instruction Mohammed V, Hay Riad, 10100 Rabat, Maroc.
authors.forename: H
authors.initials: H
authors.lastname: El Jadi
authors.affiliation: Service d'endocrinologie et métabolisme, hôpital militaire d'instruction Mohammed V, Hay Riad, 10100 Rabat, Maroc.
authors.forename: A
authors.initials: A
authors.lastname: Anas Guerboub
authors.affiliation: Service d'endocrinologie et métabolisme, hôpital militaire d'instruction Mohammed V, Hay Riad, 10100 Rabat, Maroc.
authors.forename: S
authors.initials: S
authors.lastname: Elmoussaoui
authors.affiliation: Service d'endocrinologie et maladies métaboliques, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France.
authors.forename: H
authors.initials: H
authors.lastname: Mayaudon
authors.affiliation: Service de chirurgie thoracique, hôpital militaire d'instruction Mohammed V, Hay Riad, 10100 Rabat, Maroc.
authors.forename: E
authors.initials: E
authors.lastname: Hassane Kabiri
authors.affiliation: Service d'endocrinologie et métabolisme, hôpital militaire d'instruction Mohammed V, Hay Riad, 10100 Rabat, Maroc.
authors.forename: K
authors.initials: K
authors.lastname: Hakkou
authors.affiliation: Service d'endocrinologie et métabolisme, hôpital militaire d'instruction Mohammed V, Hay Riad, 10100 Rabat, Maroc.
authors.forename: G
authors.initials: G
authors.lastname: Belmejdoub
mesh_terms: D000182:ACTH Syndrome, Ectopic / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D002276:Carcinoid Tumor / Q000150:complications*; D003480:Cushing Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010257:Paraneoplastic Syndromes / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy
keywords: Classical carcinoid tumor; Paraneoplastic Cushing's syndrome; Positron emission tomography; Syndrome de cushing paranéoplasique; Tomographie par émission de positons; Tumeur carcinoïde typique