Endocrine Abstracts

Background: Ectopic ACTH syndrome (EAS) is a rare, severe condition covering a wide spectrum of tumors of different location and aggressiveness with a predominance of bronchial carcinoids and small-cell lung carcinomas. The usual poor prognosis of patients with EAS require prompt management of the disease. The ideal treatment is complete excision of the ACTH-secreting tumor, once hypercortisolemia is under control with medical therapy. We report a case of a patient with high surgical risk and intolerance to cortisol-lowering drug, in which hypercortisolemia has been successfully treated with radiofrequency ablation of a lung carcinoid tumor.

Case presentation: A 78-year-old woman was referred for a rapidly progressive ACTH-dependent Cushing syndrome (CS). Biological tests and mainly high urinary free cortisol excretion suggested the presence of Cushing’s syndrome due to ectopic ACTH production. Imaging studies detected a pulmonary nodule of 11 mm in the left upper lobe. A CT-guided biopsy of the lesion was performed, confirming a well-differentiated carcinoid tumor with Ki67 index < 10%. The patient started therapy with ketoconazole, but rapidly developed severe gastro-intestinal side effects with dehydration. Due to a very high surgical risk, lung resection was prohibited by the multidisciplinary team and a radiofrequency ablation of the lung carcinoid tumor was performed without major complication. The procedure allowed a rapid control of hypercortisolism and improvement of CS.

Conclusion: In conclusion, we show that radiofrequency ablation may be an efficient alternate treatment for the management of high surgical risk patients with ectopic ACTH syndrome secondary to a well-differentiated lung carcinoid tumor.