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Case Reports in Medicine
Volume 2014 (2014), Article ID 413136, 8 pages
http://dx.doi.org/10.1155/2014/413136
Case Report

A Challenging Case of an Ectopic Cushing Syndrome

1Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar São João, Rua Alberto Serpa No. 150/152, 4100-010 Porto, Portugal
2Faculty of Medicine, Porto University, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
3Internal Medicine Department, Centro Hospitalar São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
4Cardiothoracic Surgery Department, Centro Hospitalar São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
5Pathology Department, Centro Hospitalar S. João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal

Received 21 July 2014; Revised 15 October 2014; Accepted 21 October 2014; Published 9 November 2014

Academic Editor: Christian Koch

Copyright © 2014 Joana Menezes Nunes et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Bronchopulmonary carcinoids are rare pulmonary neoplasms although they account for most cases of ectopic ACTH syndromes. When feasible, the mainstay treatment is surgical resection of the tumor. We report the case of a 52-year-old woman with signs and symptoms suggestive of hypercortisolism for 12 months, admitted to our department because of community acquired pneumonia. Blood hormone analysis showed increased levels of ACTH and urinary free cortisol and nonsuppressibility to high- and low-dose dexamethasone tests. Pituitary MRI showed no lesion and no central-to-peripheral ACTH gradient was present in bilateral inferior petrosal sinus sampling. CRH stimulation test suggested an ectopic ACTH source. Thoracic CT scan revealed a nodular region measuring 12 mm located in the inferior lingular lobule of the left superior lung with negative uptake by 18-FDG-PET scan and negative SRS. The patient was successfully treated with an atypical lung resection and histology revealed an atypical bronchial carcinoid tumor with positive ACTH immunoreactivity. This was an interesting case because the patient was admitted due to pneumonia that may have been associated with her untreated and chronic hypercortisolism and a challenging case of ectopic ACTH syndrome due to conflicting results on the diagnostic exams.