Abstract
The aim was to describe the clinical features of patients with ectopic Cushing syndrome (ECS) from Colombia and compare these findings with other series to provide the best management for these patients. Records of patients with ECS from 1986 to 2017 were retrospectively reviewed; patients with a diagnosis of adrenal or pituitary Cushing syndrome (CS) were excluded. Fourteen patients with ECS were analyzed in this study. The mean age was 54.4 (SD 17.1) years, and the female to male ratio was 1.33:1. Regarding the etiology of ECS, four patients had lung carcinoids (28.6%), three had small-cell lung carcinoma (21.4%), three had pancreatic neuroendocrine tumors (21.4%), one had medullary thyroid cancer (7.1%), one had non-metastatic pheochromocytoma (7.1%), one had metastatic thymoma (7.1%) and one patient had an occult source of ACTH (7.1%). The most common clinical features at presentation were moon-face, muscle weakness, diabetes mellitus and hypertension. Hyperpigmentation was present in 36% of patients, and 12 patients had hypokalemia with a mean value of 2.3 mEq/L (SD 0.71). The median basal cortisol, 24-hour urinary free cortisol (UFC) and ACTH were 30.5 ug/dL (IQR 21-59 ug/dL), 2,600 ug/24 h (IQR 253-6,487 ug/24 h) and 91 pg/mL (IQR 31.9-141.9), respectively. Thirteen patients (92.8%) had the site of the primary lesion identified. Six patients had undergone a surgical intervention to address the primary tumor. Resection was curative in 28.5% of patients. Death occurred in 57.1% of patients, and the median overall survival was 27 months. Intrathoracic tumors had the most aggressive behavior. ECS is a rare disease; however, it is associated with high morbidity and mortality. A rapid intervention supported by an interdisciplinary group is required to improve overall survival and quality of life.
Highlights
Ectopic Cushing syndrome (ECS) is the least frequent etiology of all Cushing syndrome (CS) types (5%15%) [1]
We found 14 cases of ECS; 8 were female and 6 were male
Most of the primary tumors were located in the thorax (57.1%): four tumors were lung carcinoids, three were small cell lung carcinomas (SCLC) and one patient
Summary
Ectopic Cushing syndrome (ECS) is the least frequent etiology of all Cushing syndrome (CS) types (5%15%) [1]. ECS is caused by the excessive synthesis and secretion of adrenocorticotropic hormone (ACTH) and/or corticotropin releasing hormone (CRH) from tumor cells, usually of neuroendocrine origin [2]. The prevalence of Cushing syndrome in Colombia is unknown and this is one of the few studies of this disease in this country. There is no clear characterization of ECS in low- or mediumincome countries such as Colombia. Clinicians from these areas must extrapolate from data presented by developed countries, which have a different prevalence of chronic and infectious diseases as well as social conditions. Limited data from similar countries have been presented before [4,5,6,7,8], the epidemiology of countries such as Mexico may differ
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