DIAGNOSTIC AND THERAPEUTIC CHALLENGES IN A RARE CASE FLORID CUSHING’S SYNDROME DUE TO ECTOPIC ACTH SECRETION FROM BRONCHIAL CARCINOID AND EMPTY SELLA: A CASE REPORT

Dr. Samia A. Bokhari, Dr. Patan Murthuza Khan, Dr. Shahad J. Ashgar*, Dr. Bashayer B. Almalki,
Dr. Muneera Al Shareef and Dr. Saeed J Alzahrani

ABSTRACT

Objective: Ectopic Cushing’s syndrome (EAS) is a rare disorder. The incidence of EAS varies from .2- 5 cases per million per year. The Ectopic Adrenocarticotrophic harmone(ACTH) secretion primarily from small cell carcinoma and carcinoid of lung. Chronic hypercortisolism due to EAS causes Cushing’s syndrome (CS) with significant morbidity and mortality. Early diagnosis and management of EAS is essential to ameliorate multiple symptoms and complications of CS. The purpose of this case report is to highlight challenges and difficulties in diagnosis and management of EAS. Case Presentation: A 72 year presented with progressive weight gain, proximal muscle weakness, shortness in breath on mild exertion and new onset of diabetes and persistent hypokalemia. Clinically she had signs and symptoms of CS. Laboratory tests and radiological imaging was in favor of EAS due to possible bronchial carcinoid. Confirmatory tests and surgery couldn’t be done due multiple acute complications and poor general health. On multidisciplinary team consensus decision she was treated with octreitide. She showed excellent sustained response to somatostatin analogue octreitide physically and biochemically. Conclusion: This rare case of high lights challenges of diagnosis and management of EAS in elderly lady with multiple acute comorbid conditions hindering full investigations to confirm diagnosis and surgical intervention.

Keywords: Cushing’s syndrome, Ectopic ACTH, Bronchial carcinoid, empty sella.