CUSHING’S SYNDROM (АCTH-ectopic tumor): сase from practice
Keywords:Cushing’s syndrome, bronchogenic carcinoid
The article describes the clinical case of ectopic Cushing’s syndrome in 29 years old male. The clinical signs of adrenal syndrome (obesity, red strias, myasthenia) were present. During the laboratory examination: ACTH — 12,7 pg/ml (normal:8,3–57,8); the big dexamethasone test was conducted: cortisol before loading — 508,46 ng/ml, cortisol after loading — 392,37 ng/ml (normal 50–250). The topic diagnostics of the source of hypercortitsizm was conducted: ultrasonography of adrenal glands, radiography of the head, magnetic resonance tomography of adrenal glands and pituitary with contrast. The diagnosis was made thanks to examination: Cushing’s disease. The treatment was prescribed (mitotanum, bromcreptinum), however it was not successful: the clinical symptoms persisted and the laboratory indicators did not come back to normal. Since there were no positive dynamic, the levels of ACTH and cortisol were high and clinical symptoms remained, we assumed АCTH-ectopic tumor. The chest and abdominal multi-circle computer tomography with contrast was made for the patient and the bronchogenic carcinoid was identified. The diagnosis was specified: Cushing’s syndrome, ACTH-ectopic tumor (bronchogenic carcinoid). Patient was operated successfully and histological examination confirmed the correct diagnosis. All clinical symptoms regressed after surgical treatment. The peculiarity of this clinical case is that the final diagnosis was made only in one year after appearance of clinical signs which was due to the difficulty of diagnosing various form of Cushing’s syndrome. Magnetic resonance tomography of adrenal glands and pituitary, abdominal ultrasonography, laboratory diagnostic methods didn’t allow to make the correct diagnosis. Only the use of multi-circle computed tomography with contrast has allowed to make the correct diagnosis and conduct effective treatment for the patient
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