Case reports
Lung carcinoid related Cushing's syndrome: report of three cases
and review of the literature
K M A Amera, N B N Ibrahimb, C P Forrester-Woodc, R A Saada, M Scanlond
a Department of
Cardiothoracic Surgery, University Hospital of Wales, Heath Park,
Cardiff CF4 4XW, UK, b Department of Histopathology, Frenchay Hospital,
Bristol, c Department of
Thoracic Surgery, Bristol Royal Infirmary Hospital, Bristol, d Department
of Endocrinology, University Hospital of Wales, Cardiff, Wales
Correspondence to: Mr Amer khalid.amer{at}btinternet.com
Submitted 14 April
2000;
Accepted 31 October 2000
Three patients with lung carcinoid related Cushing's syndrome
(LCRCS) treated at Frenchay Hospital, Bristol between 1984 and 1994 are
described. The first patient presented with hyperpigmentation 13 years
after bilateral adrenalectomy. The second patient had no recurrence or
metastases 14 years after removal of a typical carcinoid tumour. The
last patient survived nine years after diagnosis of liver metastasis.
The possibility of LCRCS should be considered in every patient proved
to have Cushing's disease and bilateral adrenal enlargement on
abdominal computed tomography. Biochemical sets of investigation (for
example, adrenocorticotrophic hormone (ACTH) stimulation, dexamethasone
suppression, and metyrapone response) could be misleading and should
not be relied upon solely. Search for an ectopic ACTH source should be
called off only when ACTH has been demonstrated in the surgically
removed specimen, and most importantly, when the serum ACTH
concentration returns to normal after surgery. Lung carcinoid tumours
are compatible with long survival, and liver metastasis could prove
indolent and slowly growing.
Keywords: lung carcinoids; Cushing's syndrome; ectopic ACTH syndrome; adrenocorticotrophic hormone
© 2001 by The Fellowship of Postgraduate Medicine
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