Endocrine Abstracts

Neuroendocrine tumours are heterogenous group of diseases that can originate from any part of the gastrointestinal tract, bronchi, Thyroid and Pancreas. Tumours that arise from the endocrine Pancreas, on the islet of Pancreas, are called Pancreatic NET. Pancreatic NETs have an incidence of < 0.1 % per one million person and can lead to secretion of ectopic ACTH (1). Ectopic ACTH secretion accounts for 5-10 % of all patients presenting with ACTH dependent hypercortisolism: Small cell carcinoma of lung (SCLL) and Neuroendocrine tumours (NETs) accounts for majority of such cases (6). True CS can either be ACTH dependent or ACTH independent. ACTH dependent CS is uncommon with 1-2 cases/million of population/per year reported in the literature, with primary adenoma being source of ACTH in two-thirds of such patients. (7) Here we present a case of a 62-year-old female, who presented to Emergency department with two months history of personality changes, severe euphoria, polydipsia, dry mouth and severe peripheral oedema. Her family were quite concerned as she became very euphoric and suffered with more insomnia lately. She had walked 100000 steps in the 3 days prior to her admission. Her Euphoria rapidly progressed to a delusional state prior the admission. Our patient was even reviewed by the psychiatry team for her delusional state. Laboratory and imaging investigations revealed hypokalaemia, hyperglycaemia, ACTH dependant hypercortisolaemia. She was later diagnosed as Steroid induced psychosis by the psychiatry team. Our patient had minimal features of the typical Cushing”s syndrome at her initial present. Her Gallium PET scan detected a well differentiated 2.5 cm lesion in the pancreatic body/tail. The patient underwent a successful open distal pancreatectomy.