Acth-Dependent Cushing Syndrome Caused by Thymic Carcinoid Diagnosed After Delivery of a Healthy Child

Kumi Kobayashi, MD; Takeshi Hayashi, MD, PhD; Azusa Yamato, MD; Daisuke Matsutani, MD; Hanako Ide, MD; Yasushi Kanazawa, MD, PhD; Kennosuke Ohashi, MD; Kenji Yamashiro, MD, PhD; Katsuyoshi Tojo, MD, PhD; Masaya Sakamoto, MD, PhD; Kazunori Utsunomiya, MD, PhD

AACE Clinical Case Reports (Nov 2018)

Acth-Dependent Cushing Syndrome Caused by Thymic Carcinoid Diagnosed After Delivery of a Healthy Child

Kumi Kobayashi, MD,
Takeshi Hayashi, MD, PhD,
Azusa Yamato, MD,
Daisuke Matsutani, MD,
Hanako Ide, MD,
Yasushi Kanazawa, MD, PhD,
Kennosuke Ohashi, MD,
Kenji Yamashiro, MD, PhD,
Katsuyoshi Tojo, MD, PhD,
Masaya Sakamoto, MD, PhD,
Kazunori Utsunomiya, MD, PhD

Affiliations

Kumi Kobayashi, MD: From the Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.
Takeshi Hayashi, MD, PhD: From the Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.
Azusa Yamato, MD: From the Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.
Daisuke Matsutani, MD: From the Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.
Hanako Ide, MD: From the Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.
Yasushi Kanazawa, MD, PhD: From the Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.
Kennosuke Ohashi, MD: From the Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.
Kenji Yamashiro, MD, PhD: From the Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.
Katsuyoshi Tojo, MD, PhD: From the Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.
Masaya Sakamoto, MD, PhD: Address correspondence to Dr. Masaya Sakamoto, Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo 105-8461, Japan.; From the Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.
Kazunori Utsunomiya, MD, PhD: From the Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.

Journal volume & issue: Vol. 4, no. 6
pp. e476 – e481

Abstract

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ABSTRACT: Objective: Pregnancy with Cushing syndrome is generally rare, but it is common to have a baby with Cushing syndrome. However, there has been no report of an adrenocorticotropic hormone (ACTH)-producing carcinoid diagnosed promptly after delivery. We present the first report of a woman with untreated Cushing syndrome caused by an ACTH-producing thymic carcinoid who gave birth to a healthy child.Methods: A 21-year-old female underwent a caesarean section because of rupture of membranes at 31 weeks of pregnancy. Two months after delivery, she was aware of pedal edema, and it worsened rapidly. Two weeks later, she visited our hospital.Results: Endocrine examination revealed high levels of ACTH (527 pg/mL) and cortisol (113 μg/dL) that were not affected by overnight dexamethasone suppression tests. Subsequent chest and abdominal dynamic computed tomography showed a large mediastinal tumor (3.8 cm in diameter) and enlargement of the adrenal glands. Aided by the results of immunohistochemistry from a biopsy specimen, we made the diagnosis of ectopic ACTH-dependent Cushing syndrome, following which a tumorectomy was performed. The tumor was finally diagnosed as an atypical thymic carcinoid with positivity for synaptophysin, chromogranin A, and ACTH.Conclusion: We present the first report of a woman with untreated Cushing syndrome caused by an ACTH-producing thymic carcinoid who gave birth to a healthy child.Abbreviations: ACTH = adrenocorticotropic hormone; CS = Cushing syndrome; MEN1 = multiple endocrine neoplasia type 1

Published in AACE Clinical Case Reports

ISSN: 2376-0605 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the endocrine glands. Clinical endocrinology
Website: https://www.journals.elsevier.com/aace-clinical-case-reports

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