Cushing's Syndrome Induced by the Ectopic Production of ACTH by a Bronchial Carcinoid

Abstract

A 67-yr-old woman with Cushing's syndrome in association with a bronchial carcinoid is reported. The carcinoid tumor contained very high levels of ACTH-like material (95 mU/mg wet tumor tissue) and complete remission of the Cushing's syndrome occurred following surgical removal of the tumor. Dexamethasone suppressibility and metyrapone responsiveness were demonstrated and substantial amelioration of her cushinoid features occurred in a month of continued metyrapone and dexamethasone therapy before surgery. The results of steroid testing were similar to those in ACTH-producing bronchial carcinoid patients reported by Strott, Nugent and Tyler (Amer J Med 44: 97, 1968) and are consistent with their recommendation of employing careful measures to exclude the presence of a bronchial adenoma in all patients thought to have pituitary Cushing's syndrome before deciding on the course of therapy.