F-18 FDG PET/CT imaging of endogenous Cushing syndrome.
ABSTRACT Cushing syndrome (CS) is a rare condition, with an incidence of 2 to 4 cases per million inhabitants per year. In most cases of CS, elevated adrenocorticotropic hormone (ACTH) secretion results in excess adrenal gland cortisol secretion but usually this is from pituitary, not ectopic ACTH production. We present a case of a 52-year-old woman with lower extremity edema and weakness. Physical examination revealed alopecia, hyperpigmentation, acne, and a 4-cm right thyroid mass with lymphadenopathy. Biopsy revealed medullary thyroid carcinoma (MTC). She was also diagnosed with CS caused by ectopic ACTH production, presumably from the MTC. PET/CT showed a large mass within the right lobe of the thyroid gland, extensive metastatic disease and bilateral adrenal gland hypertrophy due to CS which initially raised concern for adrenal metastases.
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ABSTRACT: We report a rare case of ectopic adrenocorticotropic hormone (ACTH) syndrome caused by a metastatic neuroendocrine tumor (NET) of the pancreas detected by PET/CT using different tracers. A 43-year-old female patient with Cushing syndrome (CS) by suspected ectopic ACTH secretion underwent a Ga-DOTANOC and a F-FDG PET/CT. Both these functional imaging techniques revealed increased tracer uptake in a pancreatic mass and multiple liver metastases. Histology showed the presence of a mildly differentiated pancreatic NET. Ga-DOTANOC PET/CT may be a useful functional imaging method, complementary to F-FDG PET/CT, in detecting ACTH-secreting pancreatic NETs.Clinical nuclear medicine 03/2013; 38(7). DOI:10.1097/RLU.0b013e318279ec68 · 3.93 Impact Factor