title: Successful percutaneous CT-guided microwave ablation of adrenal gland for ectopic Cushing syndrome.
abstract: Adrenocorticotropic hormone production by pancreatic neuroendocrine tumor (PNET) is rare and results in hyperstimulation of the adrenal gland to produce ectopic Cushing syndrome. Our case showcases the safety and effectiveness of percutaneous CT-guided microwave ablation of the adrenal gland in a 49-year-old female with PNET and hepatic metastases who presented with ectopic Cushing syndrome despite surgical resection of the primary pancreatic tumor and left adrenal gland. Prior to ablation, the right adrenal gland measured 4.3×1.6×2.0cm and the patient had malignant hypertension with elevated morning serum cortisol level (1976nmol/L). After microwave ablation of the right adrenal gland, the hypertension resolved and the cortisol level decreased dramatically (74nmol/L). As expected after successful treatment, the patient developed adrenal insufficiency and was placed on glucocorticoid and mineralocorticoid supplementation.
authors.affiliation: London Health Sciences Centre - Victoria Hospital, Western University - Department of Medical Imaging, 800 Commissioners Road East, London, Ontario N6A 5W9, Canada. Electronic address: rebeccazener@gmail.com.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Zener
authors.affiliation: London Health Sciences Centre - Victoria Hospital, Western University - Department of Medical Imaging, 800 Commissioners Road East, London, Ontario N6A 5W9, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Zaleski
authors.affiliation: St. Joseph's Health Care, Western University - Division of Endocrinology, 286 Grosvenor Street, London, Ontario N6A 4V2, Canada.
authors.forename: Stan H
authors.initials: SH
authors.lastname: Van Uum
authors.affiliation: London Health Sciences Centre - Victoria Hospital, Western University - Department of Surgery, 800 Commissioners Road East, London, Ontario N6A 5W9, Canada.
authors.forename: Daryl K
authors.initials: DK
authors.lastname: Gray
authors.affiliation: London Health Sciences Centre - Victoria Hospital, Western University - Department of Medical Imaging, 800 Commissioners Road East, London, Ontario N6A 5W9, Canada.
authors.forename: Amol
authors.initials: A
authors.lastname: Mujoomdar
mesh_terms: D055011:Ablation Techniques / Q000379:methods*; D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D000311:Adrenal Glands / Q000000981:diagnostic imaging / Q000601:surgery*; D003480:Cushing Syndrome / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008872:Microwaves; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
keywords: Adrenal ablation; Cushing's syndrome; Neuroendocrine tumor