title: Bilateral symmetrical adrenal hypermetabolism on FDG PET/CT due to Cushing syndrome in well differentiated neuroendocrine carcinoma.
abstract: The (18)F-FDG PET/CT scan has been suggested for whole-body imaging to identify ectopic adrenocorticotrophic hormone secreting tumours, but there are some challenges involved. The case of a patient is presented, who was admitted with the pre-diagnosis of ectopic ACTH syndrome. On the CT, a nodular lesion was detected in the medial segment of the right lung. The FDG uptake of the lesion seemed to be increased visually, but was not pathological quantitatively (SUVmax: 1.8) on the PET/CT. There was also diffuse increased uptake (SUVmax: 14.2) in the enlarged adrenal glands. The lesion was reported as a possible malignant lesion with low FDG affinity, such as a low grade neuroendocrine tumour, while the diffuse enlarged adrenal glands with high uptake were interpreted as diffusely hyperplasic, due to Cushing's syndrome. The patient was treated with a surgical wedge resection. The histopathological diagnosis confirmed that the tumour was a grade 1 well-differentiated neuroendocrine carcinoma.
authors.affiliation: Trakya University Medical Faculty Hospital, Department of Nuclear Medicine, Turkey. Electronic address: dr.gulege@yahoo.com.
authors.forename: G E
authors.initials: GE
authors.lastname: Aktas
authors.affiliation: Trakya University Medical Faculty Hospital, Department of Nuclear Medicine, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Soyluoglu Demir
authors.affiliation: Trakya University Medical Faculty Hospital, Department of Nuclear Medicine, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Sarikaya
mesh_terms: D000182:ACTH Syndrome, Ectopic / Q000000981:diagnostic imaging* / Q000209:etiology; D018278:Carcinoma, Neuroendocrine / Q000000981:diagnostic imaging* / Q000378:metabolism; D003480:Cushing Syndrome / Q000150:complications* / Q000175:diagnosis; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography; D019275:Radiopharmaceuticals
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D006854:Hydrocortisone
keywords: (18)F-FDG PET/CT; (18)F-FDG PET/TC; Adrenal metastasis; Bilateral adrenal hyperplasia; Carcinoma neuroendocrino; Cushing's syndrome; Hiperplasia adrenal bilateral; Metástasis adrenal; Neuroendocrine carcinoma; PET; Síndrome de Cushing