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Diagnostic difficulties in periodic Cushing's syndrome.
  1. A. B. Walker,
  2. G. P. Leese,
  3. J. P. Vora
  1. Department of Medicine, Royal Liverpool University Hospital, UK.


    A 22-year-old black woman presented with symptoms suggestive of Cushing's syndrome three years after chemotherapy for a presumed teratoma with cervical lymphadenopathy. Initially, the absence of clinical signs and the demonstration of two normal 24 h urinary free cortisols appeared to exclude the diagnosis, but an ectopic adrenocorticotropin-producing thymic carcinoid was subsequently removed surgically. Cushing's syndrome due to ectopic adrenocorticotropin production can be difficult to diagnose, particularly if there is periodic hormonogenesis.

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