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Open AccessCase Report

ACTH-dependent Hypercortisolemia in a Patient with a Pituitary Microadenoma and an Atypical Carcinoid Tumour of the Thymus

Clinic of Endocrinology, Diabetology and Internal Medicine, Department of Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Żołnierska 18, 10-561 Olsztyn, Poland
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Medicina 2019, 55(12), 759; https://doi.org/10.3390/medicina55120759
Received: 31 October 2019 / Revised: 19 November 2019 / Accepted: 22 November 2019 / Published: 27 November 2019
Cushing’s syndrome (CS) is a set of clinical symptoms which occur as a result of hypercortisolemia. Endogenous ACTH-dependent CS related to an ectopic ACTH-secreting tumour constitutes 12%–17% of CS cases and is one of the most common causes of paraneoplastic syndromes. This study presents a case of a 31 year-old man with diabetes, hypertension, rosacea, purple stretch marks and hypokalemia. Findings of diagnostic procedures include high concentrations of cortisol and ACTH, pituitary microadenoma and a tumour in the anterior mediastinum. Dynamic hormone tests determined the source of excess hormone secretion and ectopic ACTH-dependent CS was diagnosed. Due to increasing symptoms of superior vena cava syndrome, an emergency resection of almost the whole tumour was performed, with only a small part of the upper pole left because of the proximity of large vessels and a risk of damaging them. On the basis of histopathological tests, an atypical carcinoid tumour of the thymus was identified. Immediately after the surgical procedure, there was a significant reduction of clinical and laboratory traits of hypercortisolemia, yet, during the 46 weeks of postoperative observation, despite chemotherapy, the progression of residual masses of the tumour occurred with metastases and increased hormone indices. The presented case shows and discusses the differentiation of ACTH-dependent hypercortisolemia and its causes, difficulties in surgical therapy and chemotherapy, as well as prognosis for atypical carcinoid of the thymus, which is a rare disease. View Full-Text
Keywords: ACTH-dependent hypercortisolemia; atypical thymic carcinoid; pituitary microadenoma; paraneoplastic syndrome ACTH-dependent hypercortisolemia; atypical thymic carcinoid; pituitary microadenoma; paraneoplastic syndrome
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MDPI and ACS Style

Baranowska-Jurkun, A.; Szychlińska, M.; Matuszewski, W.; Modzelewski, R.; Bandurska-Stankiewicz, E. ACTH-dependent Hypercortisolemia in a Patient with a Pituitary Microadenoma and an Atypical Carcinoid Tumour of the Thymus. Medicina 2019, 55, 759.

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