A Case of Pulmonary Carcinoid Tumor with a Superimposed Aspergilloma Presenting As a Covert Ectopic Adrenocorticotropic Hormone Syndrome
Ectopic adrenocorticotropic hormone (ACTH) syndrome is a challenging diagnosis only responsible for approximately 10% of Cushing syndrome cases. It has been associated with a variety of benign and malignant tumors including a carcinoid tumor accompanied by aspergilloma in our case that was significa...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2017-06-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | http://journal.frontiersin.org/article/10.3389/fendo.2017.00123/full |
| _version_ | 1829099049907650560 |
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| author | Kyoung Jin Kim Ji Hee Yu Nan Hee Kim Young Hye Kim Young Sik Kim Ji A Seo |
| author_facet | Kyoung Jin Kim Ji Hee Yu Nan Hee Kim Young Hye Kim Young Sik Kim Ji A Seo |
| author_sort | Kyoung Jin Kim |
| collection | DOAJ |
| description | Ectopic adrenocorticotropic hormone (ACTH) syndrome is a challenging diagnosis only responsible for approximately 10% of Cushing syndrome cases. It has been associated with a variety of benign and malignant tumors including a carcinoid tumor accompanied by aspergilloma in our case that was significantly difficult to be detected. We report a patient over 70 years old with uncontrolled hypertension and hypokalemia presenting with generalized edema. Laboratory results revealed ACTH-dependent Cushing syndrome, but imaging studies did not show any discrete lesions secreting ACTH. The petrosal to peripheral ACTH gradient resulted in no evidence of pituitary adenoma. As the only lesion suspicious for ectopic ACTH secretion was a right lower round cystic lesion that did not appear to be a carcinoid tumor on computed tomography scan of the chest, the patient underwent video-assisted thoracic surgical resection to provide a definitive diagnosis. The final diagnosis was a small ectopic ACTH-secreting carcinoid tumor with unusual superimposed aspergilloma in the periphery of the lung. Postoperatively, the abnormal endocrine levels were normalized, and all of the clinical symptoms and signs were ameliorated. This is an informative case of ectopic ACTH syndrome (EAS) that was the cause of hypokalemia, hypertension, metabolic alkalosis, and hypercortisolism despite its poorly specific cushingoid morphology and uncommon imaging findings. Therefore, we recommend that clinicians investigate any possible lesion as a potential source of EAS. |
| first_indexed | 2024-12-10T21:17:51Z |
| format | Article |
| id | doaj.art-f19d7ef7e3d448afa3e8a017215a5451 |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-12-10T21:17:51Z |
| publishDate | 2017-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj.art-f19d7ef7e3d448afa3e8a017215a54512022-12-22T01:33:13ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922017-06-01810.3389/fendo.2017.00123254729A Case of Pulmonary Carcinoid Tumor with a Superimposed Aspergilloma Presenting As a Covert Ectopic Adrenocorticotropic Hormone SyndromeKyoung Jin Kim0Ji Hee Yu1Nan Hee Kim2Young Hye Kim3Young Sik Kim4Ji A Seo5Division of Endocrinology, Department of Internal Medicine, Korea University College of Medicine, Seoul, South KoreaDivision of Endocrinology, Department of Internal Medicine, Korea University College of Medicine, Seoul, South KoreaDivision of Endocrinology, Department of Internal Medicine, Korea University College of Medicine, Seoul, South KoreaDepartment of Pathology, Gil Medical Center, Gachon University, Incheon, South KoreaDepartment of Pathology, Korea University College of Medicine, Seoul, South KoreaDivision of Endocrinology, Department of Internal Medicine, Korea University College of Medicine, Seoul, South KoreaEctopic adrenocorticotropic hormone (ACTH) syndrome is a challenging diagnosis only responsible for approximately 10% of Cushing syndrome cases. It has been associated with a variety of benign and malignant tumors including a carcinoid tumor accompanied by aspergilloma in our case that was significantly difficult to be detected. We report a patient over 70 years old with uncontrolled hypertension and hypokalemia presenting with generalized edema. Laboratory results revealed ACTH-dependent Cushing syndrome, but imaging studies did not show any discrete lesions secreting ACTH. The petrosal to peripheral ACTH gradient resulted in no evidence of pituitary adenoma. As the only lesion suspicious for ectopic ACTH secretion was a right lower round cystic lesion that did not appear to be a carcinoid tumor on computed tomography scan of the chest, the patient underwent video-assisted thoracic surgical resection to provide a definitive diagnosis. The final diagnosis was a small ectopic ACTH-secreting carcinoid tumor with unusual superimposed aspergilloma in the periphery of the lung. Postoperatively, the abnormal endocrine levels were normalized, and all of the clinical symptoms and signs were ameliorated. This is an informative case of ectopic ACTH syndrome (EAS) that was the cause of hypokalemia, hypertension, metabolic alkalosis, and hypercortisolism despite its poorly specific cushingoid morphology and uncommon imaging findings. Therefore, we recommend that clinicians investigate any possible lesion as a potential source of EAS.http://journal.frontiersin.org/article/10.3389/fendo.2017.00123/fullCushing syndromeectopic adrenocorticotropic hormone syndromepulmonary carcinoid tumoraspergillomahypercortisolism |
| spellingShingle | Kyoung Jin Kim Ji Hee Yu Nan Hee Kim Young Hye Kim Young Sik Kim Ji A Seo A Case of Pulmonary Carcinoid Tumor with a Superimposed Aspergilloma Presenting As a Covert Ectopic Adrenocorticotropic Hormone Syndrome Frontiers in Endocrinology Cushing syndrome ectopic adrenocorticotropic hormone syndrome pulmonary carcinoid tumor aspergilloma hypercortisolism |
| title | A Case of Pulmonary Carcinoid Tumor with a Superimposed Aspergilloma Presenting As a Covert Ectopic Adrenocorticotropic Hormone Syndrome |
| title_full | A Case of Pulmonary Carcinoid Tumor with a Superimposed Aspergilloma Presenting As a Covert Ectopic Adrenocorticotropic Hormone Syndrome |
| title_fullStr | A Case of Pulmonary Carcinoid Tumor with a Superimposed Aspergilloma Presenting As a Covert Ectopic Adrenocorticotropic Hormone Syndrome |
| title_full_unstemmed | A Case of Pulmonary Carcinoid Tumor with a Superimposed Aspergilloma Presenting As a Covert Ectopic Adrenocorticotropic Hormone Syndrome |
| title_short | A Case of Pulmonary Carcinoid Tumor with a Superimposed Aspergilloma Presenting As a Covert Ectopic Adrenocorticotropic Hormone Syndrome |
| title_sort | case of pulmonary carcinoid tumor with a superimposed aspergilloma presenting as a covert ectopic adrenocorticotropic hormone syndrome |
| topic | Cushing syndrome ectopic adrenocorticotropic hormone syndrome pulmonary carcinoid tumor aspergilloma hypercortisolism |
| url | http://journal.frontiersin.org/article/10.3389/fendo.2017.00123/full |
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