Endocrine Abstracts

A man presented at age 32 with clinical features of Cushing’s syndrome and biochemical investigations were consistent with ectopic ACTH. The only potential source on imaging was a 5 mm right lung nodule on chest CT but which was too small to biopsy. Medical therapy was not successful at controlling his Cushing’s features so he was referred for thoracotomy. Following lobectomy, the lung nodule was found to be a carcinoid tumour. Post operatively, the patient’s symptoms improved. He remained well for many years. 11 years later he represented with similar symptoms and recurrence of ACTH-dependent Cushing’s syndrome was confirmed. A CT thorax, abdomen and pelvis revealed no abnormality but an octreotide scan suggested recurrence of disease a right infrahilar lymph node. He underwent lobectomy with lymphadenectomy for recurrent typical carcinoid in his mediastinal glands. Postoperatively, his symptoms improved. To date he has not shown any signs of recurrence and is doing very well. This case highlights the major diagnostic and therapeutic challenges associated with ectopic ACTH-secreting lesions. In addition, it points out the importance of long-term follow-up even after surgical resection and apparent cure of this condition.