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Gastric carcinoid with ectopic production of ACTH and β‐MSH
Author(s) -
Hirata Yukio,
Sakamoto Noboru,
Yamamoto Hironosuke,
Matsukura Shigeru,
Imura Hiroo,
Okada Satoshi
Publication year - 1976
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(197601)37:1<377::aid-cncr2820370148>3.0.co;2-l
Subject(s) - medicine , endocrinology , metyrapone , excretion , adrenocorticotropic hormone , urinary system , cushing syndrome , dexamethasone , hormone
A 51‐year‐old woman with typical Cushing's syndrome of about 9 years duration was shown to have a gastric carcinoid tumor. Plasma levels of ACTH and cortisol were elevated and lacked the normal diurnal rhythm. Urinary excretion of steroids was unaffected by the administration of either metyrapone or dexamethasone. Fluctuation in urinary steroid excretion, as well as transient hypokalemic alkalosis and glycosuria suggested periodic hormonogenesis. The extirpated gastric carcinoid was shown to contain immunoreactive ACTH and β‐MSH. However, the biologic ACTH activity was undetectable by in vivo steroidogenic assay. By gel filtration, it was demonstrated that both tumor and plasma ACTH was predominately “big” ACTH. Although postoperatively she developed hypoadrenocorticism severe enough to require ACTH treatment, her pituitary‐adrenal function was gradually restored. This is the first documented case of ectopic ACTH syndrome caused by gastric carcinoid in which successful cure was achieved by surgery.