title: Ectopic ACTH and CRH Co-secreting Tumor Localized by 68Ga-DOTA-TATE PET/CT.
abstract: Diagnosis of ectopic adrenocorticotropic hormone (ACTH) and corticotropin-releasing hormone (CRH) co-secreting tumors causing Cushing syndrome (CS) is challenging because these tumors are rare and their diagnosis is frequently confused with Cushing disease (CD), caused by the effect of CRH on the pituitary. We report a case of a 21-year-old male patient who was referred to our institution with persistent hypercortisolemia and CS after undergoing unnecessary transsphenoidal surgery (TSS). ⁶⁸Ga-DOTA-TATE PET/CT revealed increased tracer uptake in the thymus, which was histologically proven to be a neuroendocrine tumor (NET) that stained positive for ACTH and CRH. Imaging with ¹⁸F-FDG PET/CT was not diagnostic.
authors.affiliation: From the *Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD; †Center for Research in Computer Vision (CRCV), University of Central Florida, Orlando, FL; ‡Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; and §Section on Endocrinology and Genetics, Program on Developmental Endocrinology & Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (NIH), Bethesda, MD.
authors.forename: Georgios Z
authors.initials: GZ
authors.lastname: Papadakis
authors.forename: Ulas
authors.initials: U
authors.lastname: Bagci
authors.forename: Samira M
authors.initials: SM
authors.lastname: Sadowski
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Patronas
authors.forename: Constantine A
authors.initials: CA
authors.lastname: Stratakis
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D003346:Corticotropin-Releasing Hormone / Q000378:metabolism; D003480:Cushing Syndrome / Q000150:complications / Q000000981:diagnostic imaging*; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D064847:Multimodal Imaging; D018358:Neuroendocrine Tumors / Q000150:complications / Q000000981:diagnostic imaging*; D009942:Organometallic Compounds; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D013953:Thymus Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D009942:Organometallic Compounds; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; C513399:gallium Ga 68 dotatate