COLONIC ADENOCARCINOMA ASSOCIATED ECTOPIC ACTH-SECRETION - A CASE-HISTORY

A 57-year-old woman developed features of Gushing's syndrome after res ection of a Duke's C adenocarcinoma of the sigmoid colon. Biochemical and endocrine investigation indicated ectopic production of adrenocort icotrophic hormone (ACTH) as the cause for her condition. Hepatic meta stases were detected by computed tomography (CT) scan. Histology of th e original tumour displayed neuroendocrine characteristics but no defi nite evidence of ACTH synthesis. Treatment was instituted to control h er hypercortisolism, and chemotherapy initiated to reduce the producti on of ectopic hormone. A clinical, biochemical and radiological respon se was obtained with complete resolution of her Gushing's syndrome. Th e tumour relapsed after several months with distant metastases, but no further endocrine abnormality was noted. A review of ectopic ACTH pro ducing adenocarcinoma is given along with a discussion of the major pa thological and therapeutic features of the case.