Paraneoplastic Cushing's syndrome is a rare disease and is usually associated with small lung cancer or bronchial carcinoid tumour. In this case report we present an unusual case of metastatic neuroendocrine tumour of the pancreas presenting with florid Cushing's syndrome.
A 45-year-old female presented with four-month history of worsening blurred vision, dry mouth and lethargy. In the hindsight, for the past three years she had weight gain, easy bruising, oligomenorrhoea, facial flushing and difficulty with activities such as walking upstairs and above head arm activities. She was hypertensive and hypokalaemic in addition to the physical signs of facial plethora, interscapular fat pad, purple striae, central obesity, thin skin, leg bruises and proximal myopathy. Past medical history included Poland syndrome, PCOS and migraines.
A clinical diagnosis of Cushings syndrome was made and 9am cortisol and ACTH level identified to be significantly raised, re-confirmed with 48-hour low dose dexamethasone suppression test. MRI head did not identify a pituitary tumour. CT abdomen showed a tumour in the pancreatic tail with multiple metastatic lesions in the liver. Liver biopsy confirmed well differentiated neuroendocrine carcinoma. Patient was medically managed with metyrapone and spironolactone with some symptomatic improvement, and she was referred to tertiary neuroendocrine centre for further management.