ACTH overexpressing pituitary hyperplasia in a patient with ectopic ACTH-syndrome due to carcinoid of the lung

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Abstract


Ectopic ACTH-syndrome is the most diagnostically challenging  variant of endogenous hypercortisolism. Particularly difficult differential diagnosis of this syndrome is from Cushing's disease (CD), as currently there is no single test sufficiently accurate to differentiate accurately ectopic ACTH production from the pituitary. The main functional tests are based on the fact that the vast majority of ectopic ACTH production is autonomous and suppresses one from pituitary. But in some cases this is not observed, and then the data obtained all necessary laboratory and instrumental research evidence in favor of central genesis of CD in a patient with ACTH ectopic secretion, which can lead to inappropriate treatment. If you confirm the ectopic ACTH-syndrome, it may take quite a long time of searching for the pathological focus, as there is no sufficiently precise imaging and diagnostic method for determining the localization of ectopic source of ACTH production. Thus, the differential diagnosis of ACTH-dependent hypercortisolism and localization of the ectopic tumor is the cornerstone of early and radical treatment of patients. We present a difficult clinical case of a patient having a pituitary hyperplasia with excessive ACTH expression with primary ectopic ACTH syndrome caused by lung carcinoid.

Larisa Konstantinovna Dzeranova

Endocrinology Research Centre

Email: dzeranovalk@yandex.ru

Russian Federation MD, Ph.D., chief researcher at the Neuroendocrinology and osteopathies Department

Darya Viktorovna Skuridina

Endocrinology Research Centre

Author for correspondence.
Email: shurpesha@mail.ru

Russian Federation clinical resident

Iya Aleksandrovna Voronkova

Endocrinology Research Centre

Email: iya-v@yandex.ru

Russian Federation Associate in the Laboratory of Histology, immunohistochemistry with a group of Biobank

Lyudmila Yakovlevna Rozhinskaya

Endocrinology Research Centre

Email: rozh@endocrincentr.ru

Russian Federation MD, Ph.D., Professor, Head of  the Neuroendocrinology and osteopathies Department

Oksana VLadimirovna Manchenko

Endocrinology Research Centre

Email: o-manchenko@yandex.ru

Russian Federation Ph.D., researcher at the radiology department

Yuriy Alekseevich Ablitsov

N.I. Pirogov National Medico-Surgical Centre

Email: ablitsov@gmail.com

Russian Federation MD, PhD, Associate Professor

Aleksey Yur'evich Ablitsov

N.I. Pirogov National Medico-Surgical Centre

Email: nmhc@mail.ru

Russian Federation Ph.D., Associate Professor, Head of Thoracic Surgery Department

Stefani Sergeevna Bolevich

Endocrinology Research Centre

Email: alistra555@mail.ru

Russian Federation clinical resident

Andrey Yur'evich Grigor'ev

Endocrinology Research Centre

Email: medway26@me.com

Russian Federation MD, Ph.D. Head of the  Neurosurgery Department

Ekaterina Aleksandrovna Pigarova

Endocrinology Research Centre

Email: kpigarova@gmail.com

Russian Federation Ph.D., senior researcher at the Neuroendocrinology and osteopathies Department

Maisna Konstantinova Ankvab

Endocrinology Research Centre

Email: hirurgia777@rambler.ru

Russian Federation clinical resident

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Copyright (c) 2015 Дзеранова Л.К., Скуридина Д.В., Воронкова И.А., Рожинская Л.Я., Манченко О.В., Аблицов Ю.А., Аблицов А.Ю., Болевич С.С., Григорьев А.Ю., Пигарова Е.А., Анкваб М.К.

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