Abstract
Objective: We aimed to evaluate the value of somatostatin receptor imaging (SRI) with In-111 octreotide and Ga-68 DOTATATE in localizing ectopic ACTH producing tumors.Methods: Nineteen patients who had In-111 octreotide somatostatin receptor scintigraphy (SRS) and/or Ga-68 DOTATATE PET-CT to localize ectopic ACTH producing tumors between the years 2000 and 2012 were included retrospectively in our study. The results of SRI were compared with clinical onset, radiological findings and surgical data of the patients.Results: Sixteen In-111 octreotide SRS and five Ga-68 DOTATATE PET-CT were performed in 19 patients. In eight out of 19 patients, ectopic ACTH secretion site could be detected. In five patients, SRS showed pathologic uptake. In four of these patients, surgery revealed pulmonary carcinoid tumors and in one patient pancreatic neuroendocrine tumor. In one patient, Ga-68 DOTATATE PET-CT revealed pathologic uptake in lung nodule which came out to be pulmonary carcinoid tumor. In another patient who had resection of metastases of atypical carcinoid tumor prior to scans, new metastatic foci were detected both with SRS and Ga-68 DOTATATE PET-CT imaging. In one patient, although SRS was negative, CT which was performed three years later showed a lung nodule diagnosed as pulmonary carcinoid tumor. In 11 patients, ectopic ACTH secretion site could not be detected. In 10 of those patients, scintigraphic and radiological imaging did not show any lesions and in one patient, Ga-68 DOTATATE PET-CT was false positive.Conclusion: SRI has a complementary role with radiological imaging in localizing ectopic ACTH secretion sites. PET-CT imaging with Ga-68 peptide conjugates is a promising new modality for this indication. Conflict of interest:None declared.
Highlights
Hypersecretion of hormones from adrenal cortex causes a complex cascade of effects which is called Cushing’s syndrome
Patients Twenty-nine patients with suspicion of ectopic ACTH syndrome who were referred to our department for somatostatin receptor scintigraphy (SRS) with In-111 octreotide between 2000 and 2011 (24 patients, 29 scans) and for Ga-68 DOTATATE PET-CT between 2011 and 2012 (8 patients, 9 scans) were retrospectively evaluated
Pulmonary carcinoid tumor and in one patient pancreatic neuroendocrine tumor was the reason of ectopic ACTH secretion
Summary
Hypersecretion of hormones from adrenal cortex causes a complex cascade of effects which is called Cushing’s syndrome. Most of the abnormalities of Cushing’s syndrome are caused by abnormal amounts of cortisol [1]. Cushing’s syndrome is classified into 2 types as ACTH-dependent and ACTH-independent. Excess amount of cortisol is the result of primary adrenal overproduction in the ACTH-independent type and ACTH levels are low or in undetectable amounts. In the ACTH-dependent type, there is overproduction of ACTH either from pituitary adenoma (Cushing’s disease) or hypothalamic-pituitary dysfunction or ectopic secretion from tumors [1]. Ectopic ACTH secretion accounts for approximately 15-20% of ACTH-dependant Cushing’s syndrome [2]
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