Pigmentation and Cushing's Syndrome Due to Malignant Tumor of the Pancreas

Abstract

A 32-year-old Chinese woman presented with a classic picture of Cushing's syndrome. This responded well to bilateral adrenalectomy, but over the course of the next 2 years she became increasingly pigmented. Jaundice and an enlarged cervical lymph node drew attention to the underlying malignant condition. Autopsy revealed a tumor of the pancreas of carcinoid pattern with widespread metastases. Extracts of the tumor gave on assay 60 mU of ACTH activity and 200,000 U of MSH activity per 100 g wet tissue. The MSH activity was therefore some 1600 times that expected from its ACTH content. It is suggested that the tumor was producing either an abnormal ACTH or normal ACTH together with polypeptides resembling MSH.