title: Ectopic adrenocorticotropic hormone syndrome caused by neuroendocrine carcinoma of the colon.
abstract: A 48-year-old woman with a history of autoimmune hemolytic anemia and taking long-term corticosteroid therapy presented with a 3-month history of general fatigue, abdominal distension, and pigmentation. A computed tomography scan of the abdomen showed a tumor in the sigmoid colon and multiple metastatic nodules in the liver. A colonoscopy revealed an obstructing mass with the presence of an irregular ulcer in the sigmoid colon. Following biopsy and histopathological analysis, the patient was diagnosed with neuroendocrine carcinoma (NEC) of the colon. She received her first cycle of chemotherapy, with carboplatin and etoposide. During hospitalization, her pigmentation and hypertension worsened and hypokalemia was observed, all of which suggsted Cushing's syndrome. Her plasma adrenocorticotropic hormone (ACTH) and cortisol levels were high, and an ectopic ACTH-producing tumor was suspected. After a second chemotherapy cycle, she developed neutropenic fever and subsequently died. At autopsy, two histological types were found in the tumor: small cell carcinoma and large cell NEC. Immunohistochemical analysis revealed ACTH in the large cell NEC. This is the first reported case of an ectopic ACTH syndrome caused by NEC of the colon.
authors.affiliation: Department of Gastroenterology, Akashi Medical Center.
authors.forename: Kazuyo
authors.initials: K
authors.lastname: Fujimoto
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Nakashima
authors.forename: Kazunari
authors.initials: K
authors.lastname: Sasaki
authors.forename: Kenichi
authors.initials: K
authors.lastname: Hayashi
authors.forename: Masao
authors.initials: M
authors.lastname: Hanafusa
authors.forename: Shiei
authors.initials: S
authors.lastname: Yoshida
authors.forename: Satoshi
authors.initials: S
authors.lastname: Myojo
authors.forename: Shun-Ichi
authors.initials: SI
authors.lastname: Yoshida
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Sawai
authors.forename: Nobuya
authors.initials: N
authors.lastname: Sano
mesh_terms: D000182:ACTH Syndrome, Ectopic / Q000209:etiology*; D018278:Carcinoma, Neuroendocrine / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000556:secondary / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000556:secondary; D008875:Middle Aged; D012811:Sigmoid Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed