Endocrine Abstracts

JOINT431

Introduction: Adrenocorticotropic hormone (ACTH)- producing extra-pituitary tumors are 8-18% of endogenous cushing’s syndrome, and their frequency is often underestimated. This low frequency poses a challenge to acquiring experience in their management.

Methods: A retrospective study was undertaken at a tertiary center in Lucknow. Cases were identified through the Hospital Information System from 2000 to 2024. A cohort of eleven cases of bronchial carcinoid-secreting ACTH was retrieved. The biochemical parameters, hormonal profile, localization studies, medical and surgical treatment, and outcomes were analyzed. Data are presented as median with inter-quartile range (IQR) and percentage.

Results: Out of 11 patients, men constituted 70%. The median age of presentation was 28 years (IQR-26-43). Clinically all patients had cushingoid features and hyperpigmentation, hypokalaemia(63. 6%), hypertension(63. 6%), diabetes(72. 7%), fractures(9%), low bone mass(54. 5%) of patients. The median values of endocrine investigations are mentioned in Table 1. Localization study- Inferior petrosal sinus sampling median ratio of central to periphery was 0. 96 (IQR-0. 85-1. 08). Computed tomography and DOTANOC scan had localized lesions to right lung (54. 5%) and left lung(45. 5%). Ketoconazole usage prior to surgery in 54. 5%. Surgical excision through thoracotomy in all patients. Re-surgery was required in 27. 3%. Bilateral adrenalectomy was done in 18. 2%. Remission achieved in 81. 8% in a median duration of 28 months(IQR 3-75)(1 is lost to follow-up). No patient received antitumor treatment.

Conclusion: Ectopic cushing’s syndrome is an uncommon clinical syndrome that is associated with significant morbidity and mortality. Antitumor treatment and control of hypercortisolism is equally important and therefore a multidisciplinary approach.