ECTOPIC CUSHINGS-SYNDROME AND PULMONARY CARCINOID-TUMOR IDENTIFIED BY[IN-111-DTPA-D-PHE(1)]OCTREOTIDE

The differential diagnosis and management of Gushing's syndrome remain difficult, particularly for ectopic adrenocorticotropin (ACTH) syndro mes resulting from small bronchial carcinoids. We report the case of a 41-year-old man with ectopic ACTH-dependent Gushing's syndrome. Two c omputed tomography scans of the thorax were normal and magnetic resona nce imaging of the chest showed a 6-mm hyperintense T1-weighted area c lose to the left pulmonary hilus, interpreted as probably vascular by the radiologists. an [In-111-DTPA-D-Phe(1)]octreotide scintigraphy sca n demonstrated a positive image for somatostatin receptors in exactly the same location and surgery confirmed the presence of a small ACTH-s ecreting carcinoid tumour in the upper left lung lobe which was resect ed. Surgery cured the hypercorticism of the patient. The differential diagnosis of Cushing's syndrome and the procedure for localisation of an ACTH source are discussed.