Cargando…

Ectopic ACTH secretion (EAS) associated to a well-differentiated peritoneal mesothelioma: case report

BACKGROUND: The association between mesotheliomas and ectopic ACTH secretion has been rarely reported; we present the first case of ectopic ACTH secretion (EAS) associated with a well-differentiated peritoneal mesothelioma in whom the high dose dexamethasone suppression test (HDDST) results and plas...

Descripción completa

Detalles Bibliográficos
Autores principales: Mendoza, Carmen F., Ontiveros, Patricia, Xibillé, Daniel X., Rivera, Manuel H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4528349/
https://www.ncbi.nlm.nih.gov/pubmed/26253127
http://dx.doi.org/10.1186/s12902-015-0031-4
_version_ 1782384673266073600
author Mendoza, Carmen F.
Ontiveros, Patricia
Xibillé, Daniel X.
Rivera, Manuel H.
author_facet Mendoza, Carmen F.
Ontiveros, Patricia
Xibillé, Daniel X.
Rivera, Manuel H.
author_sort Mendoza, Carmen F.
collection PubMed
description BACKGROUND: The association between mesotheliomas and ectopic ACTH secretion has been rarely reported; we present the first case of ectopic ACTH secretion (EAS) associated with a well-differentiated peritoneal mesothelioma in whom the high dose dexamethasone suppression test (HDDST) results and plasmatic ACTH levels were similar to those found in Cushing’s disease (CD). CASE PRESENTATION: A 43-year-old hispanic woman with a 20 year history of treatment resistant diabetes mellitus and arterial hypertension. She had a full moon face, a buffalo hump, increased volume in both supraclavicular regions, purple striae in her arms and abdomen, truncal obesity, polymenorrhea and umbilical hernia. A cortisol supression test with low dose dexamethasone (LDDST) with a result of 16.6 μg/dL and ACTH plasma levels were measured at 32.6 pg/mL. The high dose dexamethasone test suppression percentage was 84.8 % and magnetic resonance imaging (MRI) showed no evidence of pituitary alterations, computed tomography (CT) showed images suggestive of uterine fibroid and an intra-abdominal tumor that correlated with an umbilical hernia, which reinforcement after contrast. Surgery was performed, finding uterine fibroids and paracolic tumor implants as well as on the omentum, bladder, bowel, ovaries and appendix. Pathology reported a well-differentiated peritoneal mesothelioma with positive immunohistochemistry for ACTH. CONCLUSIONS: Although most cases of ectopic secretion of ACTH derive from rapidly-developing lung tumors, with very high plasma ACTH levels and cortisol suppression percentages with high doses of dexamethasone under 60 %, there is a small percentage of slow-developing, chronic tumors that are biochemically undistinguishable from Cushing’s disease. Following the expert recommendations regarding imaging techniques it is possible to identify the associated tumor in most cases.
format Online
Article
Text
id pubmed-4528349
institution National Center for Biotechnology Information
language English
publishDate 2015
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-45283492015-08-08 Ectopic ACTH secretion (EAS) associated to a well-differentiated peritoneal mesothelioma: case report Mendoza, Carmen F. Ontiveros, Patricia Xibillé, Daniel X. Rivera, Manuel H. BMC Endocr Disord Case Report BACKGROUND: The association between mesotheliomas and ectopic ACTH secretion has been rarely reported; we present the first case of ectopic ACTH secretion (EAS) associated with a well-differentiated peritoneal mesothelioma in whom the high dose dexamethasone suppression test (HDDST) results and plasmatic ACTH levels were similar to those found in Cushing’s disease (CD). CASE PRESENTATION: A 43-year-old hispanic woman with a 20 year history of treatment resistant diabetes mellitus and arterial hypertension. She had a full moon face, a buffalo hump, increased volume in both supraclavicular regions, purple striae in her arms and abdomen, truncal obesity, polymenorrhea and umbilical hernia. A cortisol supression test with low dose dexamethasone (LDDST) with a result of 16.6 μg/dL and ACTH plasma levels were measured at 32.6 pg/mL. The high dose dexamethasone test suppression percentage was 84.8 % and magnetic resonance imaging (MRI) showed no evidence of pituitary alterations, computed tomography (CT) showed images suggestive of uterine fibroid and an intra-abdominal tumor that correlated with an umbilical hernia, which reinforcement after contrast. Surgery was performed, finding uterine fibroids and paracolic tumor implants as well as on the omentum, bladder, bowel, ovaries and appendix. Pathology reported a well-differentiated peritoneal mesothelioma with positive immunohistochemistry for ACTH. CONCLUSIONS: Although most cases of ectopic secretion of ACTH derive from rapidly-developing lung tumors, with very high plasma ACTH levels and cortisol suppression percentages with high doses of dexamethasone under 60 %, there is a small percentage of slow-developing, chronic tumors that are biochemically undistinguishable from Cushing’s disease. Following the expert recommendations regarding imaging techniques it is possible to identify the associated tumor in most cases. BioMed Central 2015-08-08 /pmc/articles/PMC4528349/ /pubmed/26253127 http://dx.doi.org/10.1186/s12902-015-0031-4 Text en © Mendoza et al. 2015 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Mendoza, Carmen F.
Ontiveros, Patricia
Xibillé, Daniel X.
Rivera, Manuel H.
Ectopic ACTH secretion (EAS) associated to a well-differentiated peritoneal mesothelioma: case report
title Ectopic ACTH secretion (EAS) associated to a well-differentiated peritoneal mesothelioma: case report
title_full Ectopic ACTH secretion (EAS) associated to a well-differentiated peritoneal mesothelioma: case report
title_fullStr Ectopic ACTH secretion (EAS) associated to a well-differentiated peritoneal mesothelioma: case report
title_full_unstemmed Ectopic ACTH secretion (EAS) associated to a well-differentiated peritoneal mesothelioma: case report
title_short Ectopic ACTH secretion (EAS) associated to a well-differentiated peritoneal mesothelioma: case report
title_sort ectopic acth secretion (eas) associated to a well-differentiated peritoneal mesothelioma: case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4528349/
https://www.ncbi.nlm.nih.gov/pubmed/26253127
http://dx.doi.org/10.1186/s12902-015-0031-4
work_keys_str_mv AT mendozacarmenf ectopicacthsecretioneasassociatedtoawelldifferentiatedperitonealmesotheliomacasereport
AT ontiverospatricia ectopicacthsecretioneasassociatedtoawelldifferentiatedperitonealmesotheliomacasereport
AT xibilledanielx ectopicacthsecretioneasassociatedtoawelldifferentiatedperitonealmesotheliomacasereport
AT riveramanuelh ectopicacthsecretioneasassociatedtoawelldifferentiatedperitonealmesotheliomacasereport