Abstract
Malignant pulmonary tumors are rarely accompanied by Cushing syndrome. We encountered 4 patients with adrenocorticotropic hormone (ACTH)-producing pulmonary tumors (3 with carcinoid and 1 with small cell carcinoma). All patients were females aged 33–76 years. In the 4 patients, diagnostic methods, surgical procedures, stage, outcome, and immunohistological findings were evaluated. Subtotal resection of the anterior lobe of the pituitary gland had been performed in 3 patients. However, ACTH did not decrease, and further examination revealed pulmonary tumors. Preoperative blood sampling by catheter examination was performed in 2 patients, of whom 1 showed increased ACTH. Intraoperative blood sampling showed increased ACTH in 1 patient. Lobectomy combined with mediastinal lymph node dissection was performed in 3 patients and lobectomy alone (video-assisted thoracoscopic surgery) in 1. All patients showed a decrease in ACTH after operation without tumor recurrence. Diagnosis is possible by measuring ACTH in pulmonary arterial wedge blood obtained by catherization or in pulmonary venous blood obtained during operation. Surgical resection is effective for ectopic ACTH-producing pulmonary tumors.
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References
Liddle GW, Nicholson WE, Island DP, Orth DN, Abe K, Lowder SC. Clinical and laboratory studies of ectopic humoral syndromes. Recent Prog Horm Res 1969; 25: 283–314.
Pass HI, Doppman JL, Nieman L, Stovroff M, Vetto J, Norton JA, et al. Management of the ectopic ACTH syndrome due to thoracic carcinoids. Ann Thorac Surg 1990; 50: 52–7.
Zeiger MA, Pass HI, Doppman JD, Nieman LK, Chrousos GP, Cutler GB, Jr, et al. Surgical strategy in the management of non-small cell ectopic adrenocorticotropic hormone syndrome. Surgery 1992; 112: 994–1001.
Kulke MH, Mayer RJ. Carcinoid tumors. N Engl J Med 1999; 340: 858–68.
Odell WD, Appleton WS. Humoral manifestations of cancer, Williams Textbook of Endocrinology. In: Wilson JD, Fosterr DW, ed. Philadelphia: WB Saunders, 1990: 1327–34.
Suda T. Synthesis and release of CRF and ACTH in ectopic CRF/ACTH-producing tumors. Nippon Naibunpi Gakkai Zasshi 1994; 70: 17–24.
Shrager JB, Wright CD, Wain JC, Torchiana DF, Grillo HC, Mathisen DJ. Bronchopulmonary carcinoid tumors associated with Cushing's syndrome: A more aggressive variant of typical carcinoid. J Thorac Cardiovasc Surg 1997; 114: 367–75.
Doppman JL, Loughlin T, Miller DL, Pass HI, Chrousos GP, Cutler GB, et al. Identification of ACTH-producing intrathoracic tumors by measuring ACTH levels in aspirated specimens. Radiology 1987; 163: 501–3.
Marty-Ane C, Costes V, Pujol J, Alauzen M, Baldet P, Mary H. Carcinoid tumors of the lung: Do atypical features require aggressive management? Ann Thorac Surg 1995; 59: 78–83.
Travis WD, Rush W, Flieder DB, Falk R, Fleming MV, Gal AA, et al. Survival analysis of 200 pulmonary neuroendocrine tumors with clarification of criteria for atypical carcinoid and its separation from typical carcinoid. Am J Surg Pathol 1998; 22: 934–44.
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Sakuraba, M., Murasugi, M., Oyama, K. et al. Diagnosis and surgical treatment of ectopic adrenocorticotropic hormone-producing pulmonary tumors accompanied by Cushing syndrome. Jpn J Thorac Caridovasc Surg 51, 656–659 (2003). https://doi.org/10.1007/s11748-003-0004-9
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DOI: https://doi.org/10.1007/s11748-003-0004-9