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Cyclical Cushing's Syndrome Due to Bronchial Carcinoid: Early Diagnosis and Prompt Treatment.


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Cyclical Cushing's Syndrome Due to Bronchial Carcinoid: Early Diagnosis and Prompt Treatment.

CME Review Article #6


Endocrinologist. 18(2):95-100, March/April 2008.


Hamid, Zulekha MD +++; Faas, Fred H. MD *+



We hereby describe a patient with cyclical Cushing's syndrome due to ectopic production of adrenocorticotropic hormone (ACTH) by a bronchial carcinoid tumor, accurately diagnosed and treated within a short period of time. In addition we describe for the first time careful assessment of cortisol levels in the postoperative period without hormone replacement demonstrating limited need for steroid replacement. A 43-year-old female patient was referred for evaluation of Cushing's syndrome. The diagnosis was made 2 months prior, because of the symptoms and elevated serum cortisol and urine free cortisol after a dexamethasone suppression test. Her symptoms improved and results of our laboratory studies were normal. Two months later symptoms developed again with elevated urine free cortisol and a paradoxical response to low and high-dose dexamethasone suppression test. The corticotrophin releasing hormone test suggested a nonpituitary origin. Magnetic resonance imaging of the pituitary was negative. Computed tomography and magnetic resonance imaging of the chest revealed a nodule in the right lung. Octreotide scan showed increased uptake in that area. She had a right lobectomy. Pathology revealed carcinoid tumor with ACTH staining. The cortisol levels were reduced, but steroid supplementation was not required for 2 weeks, supporting the cyclical nature of disease. This is a rare case of cyclical CS due to a bronchial carcinoid. High index of clinical suspicion and careful repeated laboratory evaluation over time is required to establish the diagnosis. Careful postoperative monitoring of cortisol values is needed. After resection of the ectopic source of ACTH, steroid supplementation may not always be needed.


? 2008 Lippincott Williams & Wilkins, Inc.

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  • 1 year later...

Hi Mary. I don't think we have ever talked on here yet. I love this site. Dave actually mentioned something about carcinoid to me the other day because of one of my posts...


"I get out of breath doing simple things. Not only does walking up one flight of steps hurt, but I am totaly out of breath by about the fifth step. I have to rest at the top of one flight of steps.

I also get out of breath talking, and when I take a shower I am out of breath when I get done.

Does this stuff happen to anyone else? "


Thats what I had written and he mentioned it to me. I had also mentioned later on that I weeze real bad in aerobics class... didn't mention that I get dizzy though. Last time I was at the Doc too my BP was 160/100.. but they just blew it off!!!

What do you think?

I just want to thank you for this website... I'm sure it has saved so many people.

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accurately diagnosed and treated within a short period of time :) music to my ears...lucky lady.



Thanks Mary, would be interested to read a full copy, if one pops up, & see what the CRH response was , not a lot, you'd think.. V interesting on the paradoxical response to dex...wonder on the hows on that one..co existing adrenal nodules ? or AVP elicited, or even lower ACTH causing improving edema response to dex from making the lady P ? sounds scarily familiar.

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