Challenges in the diagnosis and management of Cushing’s syndrome due to ectopic ACTH from bronchial carcinoid

Abstract

Despite the advances in biochemical methods and imaging techniques, Cushing’s syndrome (CS) related to ectopic adrenocorticotrophic hormone (ACTH) secretion continues to pose diagnostic and therapeutic challenges to the clinician. The work up involves establishment of endogenous Cushing’syndrone, diagnosis of ACTH dependency, localization of the source of ACTH secretion and rapid biochemical control of hypercortisolaemia. The diagnostic pathway is made difficult by recurrent sepsis, relative hypoadrenalism, drug side effects as well as unmasked incidental lesions. We report a patient presenting with Cushing’s syndrome associated with ectopic ACTH secretion from abronchial carcinoid whose management presented multiple diagnostic and therapeutic challenges.

Keywords

• cushing’s syndrome, ectopic adrenocorticotrophic hormone, hypercortisolaemia, hypoadrenalism, incidental lesion, small cell carcinoma of lung