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Cushing's syndrome due to a bronchial ACTH-secreting carcinoid successfully treated with radiofrequency ablation (RFA).
[cushing syndrome]
The
ectopic
production
of
ACTH
is
responsible
for
approximately
10
%
of
cases
of
Cushing
's
syndrome
.
Whenever
possible
,
once
hypercortisolemia
is
under
control
with
medical
therapy
,
the
final
treatment
consists
of
surgical
excision
of
the
tumor
.
We
report
a
case
of
a
patient
with
high
surgical
risk
and
poor
response
to
medical
therapy
in
which
hypercortisolemia
has
been
successfully
treated
with
radiofrequency
ablation
of
the
bronchial
carcinoid
tumor
.
A
43
-
year
-old
woman
came
to
our
hospital
because
of
severe
and
rapidly
worsening
signs
and
symptoms
of
hypercortisolism
over
the
previous
3
months
.
Hormonal
tests
suggested
the
presence
of
Cushing
's
syndrome
due
to
ectopic
ACTH
production
.
Imaging
studies
detected
an
8
-
mm
pulmonary
nodule
with
fluorine-
18
-
fluorodeoxyglucose
uptake
localized
in
the
middle
right
lobe
.
The
patient
started
therapy
with
ketoconazole
with
poor
response
.
Middle
right
lobectomy
was
indicated
but
,
due
to
the
patient
's
very
high
surgical
risk
,
a
thermal
ablation
with
radiofrequency
of
the
bronchial
nodule
was
performed
.
After
the
procedure
,
ACTH
and
cortisol
levels
dropped
and
fluorine-
18
-
fluorodeoxyglucose
positron
emission
tomography
showed
complete
response
to
treatment
.
Clinical
conditions
progressively
improved
,
and
6
weeks
later
,
the
patient
underwent
middle
lobectomy
without
complications
.
Histology
showed
a
0
.
7
-
cm
ACTH-producing
typical
bronchial
carcinoid
tumor
.
Thermal
ablation
with
radiofrequency
allows
achieving
a
rapid
control
of
hypercortisolism
with
subsequent
improvement
of
symptoms
.
This
procedure
should
therefore
be
considered
as
a
viable
therapeutic
option
in
those
cases
of
bronchial
ACTH-secreting
tumors
in
which
the
surgical
approach
is
initially
contraindicated
.
Diseases
Validation
Diseases presenting
"poor response"
symptom
alpha-thalassemia
carcinoma of the gallbladder
congenital adrenal hyperplasia
cushing syndrome
esophageal adenocarcinoma
hodgkin lymphoma, classical
inclusion body myositis
werner syndrome
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