Lung carcinoid related Cushing's syndrome: report of three cases and review of the literature

Three patients with lung carcinoid related Gushing's syndrome (LCRCS) treat ed at Frenchay Hospital, Bristol between 1984 and 1994 are described. The f irst patient presented with hyperpigmentation 13 years after bilateral adre nalectomy. The second patient had no recurrence or metastases 14 years afte r removal of a typical carcinoid tumour. The last patient survived nine yea rs after diagnosis of liver metastasis. The possibility of LCRCS should be considered in every patient proved to have Gushing's disease and bilateral adrenal enlargement on abdominal computed tomography. Biochemical sets of i nvestigation (for example, adrenocorticotrophic hormone (ACTH) stimulation, dexamethasone suppression, and metyrapone response) could be misleading an d should not be relied upon solely. Search for an ectopic ACTH source shoul d be called off only when ACTH has been demonstrated in the surgically remo ved specimen, and most importantly, when the serum ACTH concentration retur ns to normal after surgery. Lung carcinoid tumours are compatible with long survival, and liver metastasis could prove indolent and slowly growing.