OCCULT ECTOPIC ACTH-SECRETION DUE TO RECURRENT LUNG CARCINOID - LONG-TERM CONTROL OF HYPERCORTISOLISM BY CONTINUOUS SUBCUTANEOUS INFUSION OF OCTREOTIDE

We report on a woman with clinical Gushing's syndrome confirmed by bio chemical data. The Gushing's syndrome was shown to be ACTH dependent a nd inferior petrosal sinus sampling pointed to an ectopic source. Afte r resection of a lung carcinoid a well documented remission of Gushing 's syndrome was obtained. At recurrence of Gushing's syndrome 18 month s later the ACTH source could not be located despite extensive diagnos tic procedures, Clinical and biochemical control of hypercortisolism w as achieved by continuous subcutaneous infusion of octreotide. During a brief interruption of treatment recurrence of clinical and biochemic al signs and symptoms of Gushing's syndrome were demonstrated. We conc lude that in this case of occult ectopic ACTH secretion, presumably du e to recurrent lung carcinoid, continuous subcutaneous infusion therap y with octreotide resulted in clinical and metabolic control of Gushin g's syndrome for 8 years. In addition excellent tumour growth control was achieved as repeated searches for tumour recurrence or metastasis remained negative.