ECTOPIC ACTH-SECRETION DUE TO A BRONCHOPULMONARY CARCINOID LOCALIZED BY SOMATOSTATIN RECEPTOR SCINTIGRAPHY

We present the case of a 65-year-old woman with an adrenocorticotropic hormone (ACTH) secreting bronchopulmonary carcinoid. This patient sho wed the typical long history of Cushing's syndrome, including hypokali emia, impaired glucose tolerance, high levels of ACTH and beta-endorph in, and coproduction of other peptides. At the onset of clinical sympt oms in 1979 an adrenal adenoma was suspected, and left-sided adrenalec tomy was performed. The symptoms soon recurred, and the diagnosis of A CTH-dependent Cushing's syndrome was made. As no ACTH-secreting tumor was found, the right adrenal was resected, and the patient was followe d up regularly. Fourteen years later chest roentgenography and compute d tomography revealed a para-aortic pulmonary lesion, which was suspic ious for a bronchopulmonary carcinoid. ACTH and beta-endorphin were ex cessively, pancreatic polypeptide slightly elevated at that time. The final diagnosis was made using somatostatin receptor scintigraphy whic h confirmed the hormonal activity of the suspicious lesion; no additio nal focus was found. This method turned out to be not only a useful ad ditional localization technique but also a promising tool for characte rization and staging of a suspected ACTH-producing carcinoid. The tumo r was resected curatively, and the diagnosis was confirmed histologica lly.