Occult ectopic ACTH secretion due to recurrent lung carcinoid: long‐term control of hypercortisolism by continuous subcutaneous infusion of octreotide
Occult ectopic ACTH secretion due to recurrent lung carcinoid: long‐term control of hypercortisolism by continuous subcutaneous infusion of octreotide
复制标题
复发性肺类癌导致隐匿性异位 ACTH 分泌：持续皮下输注奥曲肽长期控制皮质醇增多症
作者：
A. Van den Bruel;M. Bex;J. van Dorpe;W. Heyns;R. Bouillon
我们报告一名妇女的临床库欣综合征证实的生化数据。库欣综合征表现为促肾上腺皮质激素依赖性，岩下窦取样提示异位源。肺类癌切除后，库欣综合征缓解，得到了充分的记录。18个月后库欣综合征复发时，尽管进行了广泛的诊断程序，仍无法定位ACTH来源。皮质醇增多症的临床和生化控制是通过奥曲肽持续皮下输注实现的。在短暂的治疗中断期间，证实了库欣综合征的临床和生化体征和症状的复发。我们的结论是，在这种情况下，隐匿性异位ACTH分泌，可能是由于复发性肺类癌，连续皮下注射治疗奥曲肽导致库欣综合征的临床和代谢控制8年。此外，由于肿瘤复发或转移的重复搜索保持阴性，因此实现了极好的肿瘤生长控制。
We report on a woman with clinical Cushing's syndrome confirmed by biochemical data. The Cushing's syndrome was shown to be ACTH dependent and inferior petrosal sinus sampling pointed to an ectopic source. After resection of a lung carcinoid a well documented remission of Cushing's syndrome was obtained. At recurrence of Cushing's syndrome 18 months later the ACTH source could not be located despite extensive diagnostic procedures. Clinical and biochemical control of hypercortisolism was achieved by continuous subcutaneous infusion of octreotide. During a brief interruption of treatment recurrence of clinical and biochemical signs and symptoms of Cushing's syndrome were demonstrated. We conclude that in this case of occult ectopic ACTH secretion, presumably due to recurrent lung carcinoid, continuous subcutaneous infusion therapy with octreotide resulted in clinical and metabolic control of Cushing's syndrome for 8 years. In addition excellent tumour growth control was achieved as repeated searches for tumour recurrence or metastasis remained negative.