Advertisement

Pituitary

, Volume 21, Issue 5, pp 535–544 | Cite as

Two types of ectopic Cushing syndrome or a continuum? Review

  • Marta Araujo CastroEmail author
  • Mónica Marazuela Azpiroz
Article

Abstract

Background

Two types of ectopic Cushing syndrome (ECS) are described: ECS associated with aggressive neoplasms, and ECS with indolent and occult tumors, however, there is a lack of studies that thoroughly review their characteristics.

Methods

A systematic review was carried out on PUBMED of all the papers about the ECS, in order to better define the types of this subcategory of Cushing’s syndrome, highlighting the differential aspects between these subgroups.

Results

It was found that in 50% of cases the prototypic “aggressive” ECS is caused by small cell lung carcinomas (SCLC). In these cases, the clinical presentation may be atypical, predominating the signs and symptoms derived from the protein catabolism. Cortisol and ACTH levels are extremely high, the clinical presentation is abrupt (< 3–6 months) and the tumor is usually advanced, being impossible a curative treatment. On the other hand, “indolent” ECS is mainly represented by carcinoid tumors (CT). In these cases the clinical presentation overlaps enormously with that of Cushing’s disease (CD). Cortisol and ACTH levels are slightly elevated, the clinical presentation is progressive (> 6 months) and the prognosis is usually good, and a curative treatment is possible in about 75% of the cases.

Conclusion

Although there is no absolute differentiation between the two extremes of ECS, a classification could be established in two groups, guided by its clinical and biochemical characteristics, and mainly by the type and stage of the ACTH-secreting tumor. However, a small percentage of tumors do not fit in this simple grouping, and may present both phenotypes or an intermediate one.

Keywords

Ectopic Cushing syndrome Hypercortisolism Paraneoplastic Carcinoid tumor 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. 1.
    Newell-Price J (2009). Diagnosis/differential diagnosis of Cushing’s syndrome: a review of best practice. Best Pract Res Clin Endocrinol Metab 23(1):S5–S14.  https://doi.org/10.1016/S1521-690X(09)70003-X CrossRefPubMedGoogle Scholar
  2. 2.
    Sharma ST, Nieman LK, Feelders RA (2015) Cushing’s syndrome: Epidemiology and developments in disease management. Clin Epidemiol 7:281–293PubMedPubMedCentralGoogle Scholar
  3. 3.
    Newell-Price J, Bertagna X, Grossman A, Nieman L (2006) Cushing’s syndrome. Lancet 367(9522):1605–1617CrossRefPubMedGoogle Scholar
  4. 4.
    Newell-Price J, Trainer P, Besser M, Grossman A (1998) The diagnosis and differential diagnosis of Cushing’s syndrome and pseudo-Cushing’s states. Endocrin Rev 19(5):647–672Google Scholar
  5. 5.
    Isidori AM, Kaltsas GA, Pozza C, Frajese V, Newell-Price J, Reznek RHA et al (2006) The ectopic adrenocorticotropin syndrome: clinical features, diagnosis, management, and long-term follow-up. J Clin Endocrinol Metab 91(2):371–377CrossRefPubMedGoogle Scholar
  6. 6.
    Isidori AM, Lenzi A (2007) Overt and occult ectopic ACTH Syndrome. Arq Bras Endocrinol Metab 51(8):1217–1225CrossRefGoogle Scholar
  7. 7.
    Liddle GW, Givens R, Nicholson E, Island P (1965) The ectopic ACTH syndrome. Cancer Res 25(7):1057–1061PubMedGoogle Scholar
  8. 8.
    Aniszewski JP, Young WF Jr, Thompson GB, Grant CS, van Heerden JA (2001) Cushing syndrome due to ectopic adrenocorticotropic hormone secretion. World J Surg 25(7):934–940CrossRefPubMedGoogle Scholar
  9. 9.
    Ilias I, Torpy DJ, Pacak K, Mullen N, Wesley R, Nieman LK (2005) Cushing’s syndrome due to ectopic corticotropin secretion: twenty years’ experience at the National Institutes of Health. J Clin Endocrinol Metab 90(8):4955–4962CrossRefPubMedGoogle Scholar
  10. 10.
    Ejaz S, Vassilopoulou-Sellin R, Busaidy NL, Hu MI, Waguespack SG, Jimenez C et al (2011) Cushing syndrome secondary to ectopic adrenocorticotropic hormone secretion: the University of Texas MD Anderson Cancer Center Experience. Cancer 117(19):4381–4389CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Ferone D, Albertelli M (2014) Ectopic Cushing and other paraneoplastic syndromes in thoracic neuroendocrine tumors. Thorac Surg Clin 24(3):277–283CrossRefPubMedGoogle Scholar
  12. 12.
    Duran C, Eren Karanis M, Bakdik S, Aslan U, Calik M, Calik S (2016) Ectopic Cushing syndrome due to ACTH secreting atypic thymic carcinoid tumor. Chest 150(4):50ACrossRefGoogle Scholar
  13. 13.
    Phan AT, Yao JC (2008) Neuroendocrine tumors: novel approaches in the age of targeted therapy. Oncology 22(14):1617–1629PubMedGoogle Scholar
  14. 14.
    Litvak A, Pietanza MC (2016) Bronchial and thymic carcinoid tumors. Hematol Oncol Clin N Am 30(1):83–102CrossRefGoogle Scholar
  15. 15.
    Wang WQ, Ye L, Bi YF, Zhao HY, Sun SY, Tang ZY et al (2006) Six cases of ectopic ACTH syndrome caused by thymic carcinoid. J Endocrinol Invest 29(4):293–297CrossRefPubMedGoogle Scholar
  16. 16.
    De Perrot M, Spiliopoulos A, Fischer S, Totsch M, Keshavjee S (2002) Neuroendocrine carcinoma (carcinoid) of the thymus associated with Cushing’ s syndrome. Ann Thorac Surg 73(2):675–681CrossRefPubMedGoogle Scholar
  17. 17.
    Ballav C, Naziat A, Mihai R, Karavitaki N, Ansorge O, Grossman AB (2012) Mini-review: pheochromocytomas causing the ectopic ACTH syndrome. Endocrine 42(1):69–73CrossRefPubMedGoogle Scholar
  18. 18.
    Stewart PM, Gibson S, Crosby SR, Penn R, Holder R, Ferry DP et al (1994) ACTH precursors characterize the ectopic ACTH syndrome. Clin Endocrinol 40(2):199–204CrossRefGoogle Scholar
  19. 19.
    Raffin-Sanson ML, Massias JF, Dumont C, Raux-Demay MC, Proeschel MF, Luton JP et al (1996) High plasma proopiomelanocortin in aggressive adrenocorticotropin-secreting tumors. J Clin Endocrinol Metab 81(12):4272–4277PubMedGoogle Scholar
  20. 20.
    Terzolo M, Reimondo G, Alì A, Bovio S, Daffara F, Paccotti PM et al (2011) Ectopic ACTH syndrome: molecular bases and clinical heterogeneity. Ann Oncol 12(2):S83–S7Google Scholar
  21. 21.
    De Keyzer Y, Lenne F, Auzan C, Jégou S, René P, Vaudry HY et al (1996) The pituitary V3 vasopressin receptor and the corticotroph phenotype in ectopic ACTH syndrome. J Clin Invest 97(5):1311–1318CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    De Keyzer Y, Auzan C, Lenne F, Beldjord C, Thibonnier M, Bertagna XY et al (1994) Cloning and characterization of the human V3 pituitary vasopressin receptor. FEBS Lett 356(2–3):215–220CrossRefPubMedGoogle Scholar
  23. 23.
    Suda T, Tozawa F, Dobashi I, Horiba N, Ohmori N, Yamakado M et al (1993) Corticotropin-releasing hormone, proopiomelanocortin, and glucocorticoid receptor gene expression in adrenocorticotropin-producing tumors in vitro. J Clin Invest 92(6):2790–2795CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Wajchenberg BL, Mendonca BB, Liberman B, Pereira MA, Carneiro PC, Wakamatsu A et al (1994) Ectopic Adrenocorticotropic Hormone Syndrome. Endocr Rev 15(6):752 – 87PubMedGoogle Scholar
  25. 25.
    Sathyakumar S, Paul TV, Asha HS, Gnanamuthu BR, Paul MJ, Abraham DT et al (2017) Ectopic Cushing syndrome: a 10-year experience from a tertiary care center in southern India. Endocr Pract 23(8):907–914CrossRefPubMedGoogle Scholar
  26. 26.
    Viebahn R, Hiddemann W, Klink F, Bassewitz DB (1985) Thymus carcinoid. Pathol Res Pract 180(4):445–448CrossRefPubMedGoogle Scholar
  27. 27.
    Wick MR, Scott RE, Li CY, Carney JA (1980) Carcinoid tumor of the thymus: a clinicopathologic report of seven cases with a review of the literature. Mayo Clin Proc 55(4):246–254PubMedGoogle Scholar
  28. 28.
    Debelenko LV, Brambilla E, Agarwal SK, Swalwell JI, Kester MB, Lubensky IA et al (1997) Identification of MEN1 gene mutations in sporadic carcinoid tumors of the lung. Hum Mol Genet 6(13):2285–2290CrossRefPubMedGoogle Scholar
  29. 29.
    Gibril F, Chen YJ, Schrump DS, Vortmeyer A, Zhuang Z, Lubensky IA et al (2003) Prospective study of thymic carcinoids in patients with multiple endocrine neoplasia type 1. J Clin Endocrinol Metab 88(3):1066–1081CrossRefPubMedGoogle Scholar
  30. 30.
    Wick MR, Rosai J (1988) Neuroendocrine Neoplasms of the Thymus. Pathol Res Pract 183(2):188–199CrossRefPubMedGoogle Scholar
  31. 31.
    Quinkler M, Stewart PM (2003) Hypertension and the cortisol-cortisone shuttle. J Clin Endocrinol Metab 88(6):2384–2392CrossRefPubMedGoogle Scholar
  32. 32.
    Crapo L (1979) Cushing’s syndrome: a review of diagnostic tests. Metabolism 28(9):955–977CrossRefPubMedGoogle Scholar
  33. 33.
    Karageorgiadis AS, Papadakis GZ, Biro J, Keil MF, Lyssikatos C, Quezado MM et al (2015) Ectopic adrenocorticotropic hormone and corticotropin-releasing hormone co-secreting tumors in children and adolescents causing Cushing syndrome: a diagnostic dilemma and how to solve it. J Clin Endocrinol Metab 100(1):141–148CrossRefPubMedGoogle Scholar
  34. 34.
    Flack MR, Oldfield EH, Cutler GB Jr, Zweig MH, Malley JD, Chrousos GP et al (1992) Urine free cortisol in the high-dose dexamethasone suppression test for the differential diagnosis of the Cushing syndrome. Ann Intern Med 116(3):211–217CrossRefPubMedGoogle Scholar
  35. 35.
    Malchoff CD, Orth DN, Abboud C, Carney JA, Pairolero PC, Carey RM (1988) Ectopic ACTH syndrome caused by a bronchial carcinoid tumor responsive to dexamethasone, metyrapone, and corticotropin-releasing factor. Am J Med 84(4):760–764CrossRefPubMedGoogle Scholar
  36. 36.
    Lamas Oliveira C, Martínez JA, Corrales PP, Rodríguez SA, López H (2007) Metodología diagnóstica en la identificación del Cushing ectópico. Endocrin y Nutr 54(8):432 – 37CrossRefGoogle Scholar
  37. 37.
    Ritzel K, Beuschlein F, Berr C, Osswald A, Reisch N, Bidlingmaier M et al (2015) ACTH after 15 min distinguishes between Cushing’s disease and ectopic Cushing’s syndrome: a proposal for a short and simple CRH test. Eur J Endocrinol 173(2):197–204.  https://doi.org/10.1530/EJE-14-0912 CrossRefPubMedGoogle Scholar
  38. 38.
    Barbot M, Trementino L, Zilio M, Ceccato F, Albiger N, Daniele A et al (2016) Second-line tests in the differential diagnosis of ACTH-dependent Cushing’s syndrome. Pituitary 19(5):488 – 95.  https://doi.org/10.1007/s11102-016-0729-y CrossRefPubMedGoogle Scholar
  39. 39.
    Isidori AM, Kaltsas GA, Mohammed S, Morris DG, Jenkins P, Chew SL et al (2003) Discriminatory value of the low-dose dexamethasone suppression test in establishing the diagnosis and differential diagnosis of Cushing’s syndrome. J Clin Endocrinol Metab 88(11):5299–5306CrossRefPubMedGoogle Scholar
  40. 40.
    Arnaldi G, Angeli A, Atkinson AB, Bertagna X, Cavagnini F, Chrousos GP et al (2003) Diagnosis and complications of Cushing’s syndrome: a consensus statement. J Clin Endocrinol Metab 88(12):5593–5602CrossRefPubMedGoogle Scholar
  41. 41.
    Bansal V, Asmar N, Selman WR, Arafah BM (2015) Pitfalls in the diagnosis and management of Cushing’s syndrome. Neurosurg Focus 38(2):1–11CrossRefGoogle Scholar
  42. 42.
    Oldfield EH, Doppman JL, Nieman LK, Chrousos GP, Miller DL, Katz DA et al (1991) Petrosal sinus sampling with and without corticotropin-releasing hormone for the differential diagnosis of Cushing’s syndrome. N Engl J Med 325(13):897–905CrossRefPubMedGoogle Scholar
  43. 43.
    Zampetti B, Grossrubatscher E, Dalino Ciaramella P, Boccardi E, Loli P (2016) Bilateral inferior petrosal sinus sampling. Endocr Connect 5(4):R12-25CrossRefPubMedGoogle Scholar
  44. 44.
    Gahtany M, Bilbao J, Kovacs K, Horvath E, Smyth HS (2003) Juxtaposition of an ectopic corticotroph adenoma of the sphenoid sinus with orthotopic intrasellar corticotroph hyperplasia in a patient with Cushing disease: Case report. J Neurosurg 98(4):891–896CrossRefGoogle Scholar
  45. 45.
    Doppman JL, Pass HI, Nieman LK, Findling JW, Dwyer AJ, Feuerstein IM et al (1991) Detection of ACTH-producing bronchial carcinoid tumors: MR imaging vs CT. AJR Am J Roentgenol 156(1):39–43CrossRefPubMedGoogle Scholar
  46. 46.
    Boscaro M, Arnaldi G (2009) Approach to the patient with possible Cushing’s syndrome. J Clin Endocrinol Metab 94(9):3121–3131CrossRefPubMedGoogle Scholar
  47. 47.
    Deldycke A, Haenebalcke C, Taes Y (2017) Paraneoplastic Cushing syndrome, case-series and review of the literature. Acta Clin Belg 12:1–7Google Scholar
  48. 48.
    Shrager JB, Wright CD, Wain JC, Torchiana DF, Grillo HC, Mathisen DJ (1997) Bronchopulmonary carcinoid tumors associated with Cushing’s syndrome: A more aggressive variant of typical carcinoid. J Thorac Cardiovasc Surg 114(3):367 – 75CrossRefPubMedGoogle Scholar
  49. 49.
    Estopiñán V, Varela C, Riobo P, Dominguez JR, Sancho J (1987) Ectopic Cushing’s syndrome with periodic hormonogenesis–a case suggesting a pathogenetic mechanism. Postgrad Med J 63(744):887–889CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Özkan ZG, Kuyumcu S, Balköse D, Ozkan B, Aksakal N, Yılmaz EZ et al (2013) The value of somatostatin receptor imaging with In-111 Octreotide and/or Ga-68 DOTATATE in localizing Ectopic ACTH producing tumors. Mol Imaging Radionucl Ther 22(2):49–55CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Kwekkeboom DJ, Krenning EP, Bakker WH, Oei HY, Kooij PP, Lamberts SW (1993) Somatostatin analogue scintigraphy in carcinoid tumours. Eur J Nucl Med 20(4):283–292CrossRefPubMedGoogle Scholar
  52. 52.
    Reincke M, Allolio B, Arlt W, Körber C (1999) Comment on primary localization of an ectopic ACTH-producing bronchial carcinoid tumor by Indium111 pentetreotide scintigraphy. J Clin Endocrinol Metab 84(9):3399–3400CrossRefPubMedGoogle Scholar
  53. 53.
    De Bruin C, Hofland LJ, Nieman LK, van Koetsveld PM, Waaijers AM, Sprij-Mooij DM et al (2012) Mifepristone effects on tumor somatostatin receptor expression in two patients with Cushing’s syndrome due to ectopic adrenocorticotropin secretion. J Clin Endocrino Metab 97(2):455–462CrossRefGoogle Scholar
  54. 54.
    Petersenn S, Rasch AC, Presch S, Beil FU, Schulte HM (1999) Genomic structure and transcriptional regulation of the human somatostatin receptor type 2. Mol Cell Endocrinol 157(1–2):75–85CrossRefPubMedGoogle Scholar
  55. 55.
    Pacak K, Ilias I, Chen CC, Carrasquillo JA, Whatley M, Nieman LK (2004) The role of [18F]fluorodeoxyglucose positron emission tomography and [111In]-diethylenetriaminepentaacetate-D-Phe-pentetreotide scintigraphy in the localization of ectopic adrenocorticotropin-secreting tumors causing Cushing’s syndrome. J Clin Endocrinol Metab 89(5):2214–2221CrossRefPubMedGoogle Scholar
  56. 56.
    Treglia G, Castaldi P, Rindi G, Giordano A, Rufini V (2012) Diagnostic performance of Gallium-68 somatostatin receptor PET and PET/CT in patients with thoracic and gastroenteropancreatic neuroendocrine tumours: a meta-analysis. Endocrine 42(1):80–87CrossRefPubMedGoogle Scholar
  57. 57.
    Grossman AB, Kelly P, Rockall A, Bhattacharya S, McNicol A, Barwick T (2006) Cushing’s syndrome caused by an occult source: difficulties in diagnosis and management. Nat Clin Pract Endocrinol Metab 2(11):642–647CrossRefPubMedGoogle Scholar
  58. 58.
    Meinardi JR, Wolffenbuttel BH, Dullaart RP (2007) Cyclic Cushing’s syndrome: a clinical challenge. Eur J Endocrinol 157(3):245–254CrossRefPubMedGoogle Scholar
  59. 59.
    Brown RD, Van Loon GR, Orth DN, Liddle GW (1973) Cushing’s disease with periodic hormonogenesis: one explanation for paradoxical response to dexamethasone. J Clin Endocrinol Metab 36(3):445–451CrossRefPubMedGoogle Scholar
  60. 60.
    Orth DN (1995) Cushing’s syndrome. N Engl J Med 332(12):791–803CrossRefPubMedGoogle Scholar
  61. 61.
    Bailey RE (1971) Periodic hormonogenesis-a new phenomenon. periodicity in function of a hormone-producing tumor in man. J Clin Endocrinol Metab 32(3):317–327CrossRefPubMedGoogle Scholar
  62. 62.
    Sharma ST, Nieman LK (2012) Prolonged remission after long-term treatment with steroidogenesis inhibitors in Cushing’s syndrome caused by ectopic ACTH secretion. Eur J Endocrinol 166(3):531–536CrossRefPubMedGoogle Scholar
  63. 63.
    Loh KC, Gupta R, Shlossberg AH (1996) Spontaneous remission of ectopic Cushing’s syndrome due to pheochromocytoma: a case report. Eur J Endocrinol 135(4):440–443CrossRefPubMedGoogle Scholar
  64. 64.
    Liebowitz G, White A, Hadani M, Gross DJ (1997) Fluctuating hyper-hypocortisolaemia: a variant of Cushing’s syndrome. Clin Endocrinol 46(6):759–763CrossRefGoogle Scholar
  65. 65.
    Peri A, Bemporad D, Parenti G, Luciani P, Serio M, Mannelli M (2001) Cushing’s syndrome due to intermittent ectopic ACTH production showing a temporary remission during a pulmonary infection. Eur J Endocrinol 145(5):605–611CrossRefPubMedGoogle Scholar
  66. 66.
    Atkinson AB, McCance DR, Kennedy L, Sheridan B (1992) Cyclical Cushing’s syndrome first diagnosed after pituitary surgery: a trap for the unwary. Clin Endocrinol 36(3):297–299CrossRefGoogle Scholar
  67. 67.
    Mercado-Asis LB, Murayama M, Yamakita N, Morita H, Mune T, Yasuda KL et al (1991) Cortisol-suppressible dexamethasone-nonsuppressible cyclic Cushing’s disease with evidence of clinical and biochemical remission with bromocriptine. Endocrinol Jpn 38(3):315–324CrossRefPubMedGoogle Scholar
  68. 68.
    Mullan KR, Atkinson AB, Sheridan B (2007) Cyclical Cushing’s syndrome: an update. Curr Opin Endocrinol Diabetes Obes 14(4):317–322CrossRefPubMedGoogle Scholar
  69. 69.
    Kakade HR, Kasaliwal R, Jagtap VS, Bukan A, Budyal SR, Khare SH et al (2013) Ectopic ACTH-secreting syndrome: a single-center experience. Endocr Pract 19(6):1007–1014CrossRefPubMedGoogle Scholar
  70. 70.
    Li WY, Liu XD, Li WN, Dong SY, Qu XH, Gong SL et al (2016) Paraneoplastic Cushing’s syndrome associated with bronchopulmonary carcinoid tumor in youth: a case report and review of the literature. Oncol Lett 12(1):69–72CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    Hilal T (2017) Current understanding and approach to well differentiated lung neuroendocrine tumors: an update on classification and management. Ther Adv Med Oncol 9(3):189–199CrossRefPubMedGoogle Scholar
  72. 72.
    Maragliano R, Vanoli A, Albarello L, Milione M, Basturk O, Klimstra DS et al (2015) ACTH-secreting pancreatic neoplasms associated with Cushing syndrome: clinicopathologic study of 11 cases and review of the literature. Am J Surg Pathol 39(3):374–382CrossRefPubMedGoogle Scholar
  73. 73.
    Farrell WE, Stewart MF, Clark AJ, Crosby SR, Davis JR, White A (1993) Glucocorticoid inhibition of ACTH peptides: small cell lung cancer cell lines are more resistant than pituitary corticotroph adenoma cells. J Mol Endocrinol 10(1):25–32CrossRefPubMedGoogle Scholar
  74. 74.
    Page-Wilson G, Freda PU, Jacobs TP, Khandji AG, Bruce JN, Foo ST et al (2014) Clinical utility of plasma POMC and AgRP measurements in the differential diagnosis of ACTH-dependent Cushing’s syndrome. J Clin Endocrinol Metab 99(10):E1838–E45CrossRefPubMedPubMedCentralGoogle Scholar
  75. 75.
    Kameya T, Shimosato Y, Adachi I, Abe K, Kasai N, Kimura K et al (1997) Immunohistochemical and ultrastructural analysis of medullary carcinoma of the thyroid in relation to hormone production. Am J Pathol 89(3):555–574Google Scholar
  76. 76.
    Patel FB, Khagi S, Daly KP, Lechan RM, Ummaritchot V, Saif MW (2013) Pancreatic neuroendocrine tumor with ectopic adrenocorticotropin production: a case report and review of literature. Anticancer Res 33(9):4001–4005PubMedGoogle Scholar
  77. 77.
    Barbosa SL, Rodien P, Leboulleux S, Niccoli-Sire P, Kraimps JL, Caron PB et al (2005) Ectopic adrenocorticotropic hormone-syndrome in medullary carcinoma of the thyroid: a retrospective analysis and review of the literature. Thyroid 15(6):618–623CrossRefPubMedGoogle Scholar
  78. 78.
    Delisle L, Boyer MJ, Warr D, Killinger D, Payne D, Yeoh JL et al (1993) Ectopic corticotropin syndrome and small-cell carcinoma of the lung. Clinical features, outcome, and complications. Arch Intern Med 153(6):746–752CrossRefPubMedGoogle Scholar
  79. 79.
    Zaydfudim V, Stover DG, Caro SW, Phay JE (2008) Presentation of a medullary endocrine neoplasia 2A kindred with Cushing’s syndrome. Am Surg 74(7):659–661PubMedGoogle Scholar
  80. 80.
    Ghazi AA, Abbasi Dezfooli A, Amirbaigloo A, Daneshvar Kakhki A, Mohammadi F, Tirgari F et al (2015) Ectopic Cushing’s syndrome secondary to lung and mediastinal tumours—report from a tertiary care centre in Iran. Endokrynol Pol 66(1):2–9CrossRefPubMedGoogle Scholar
  81. 81.
    Isidori AM, Sbardella E, Zatelli MC, Boschetti M, Vitale G, Colao A et al (2015) Conventional and nuclear medicine imaging in ectopic Cushing’s syndrome: a systematic review. J Clin Endocrinol Metab 100(9):3231–3244CrossRefPubMedPubMedCentralGoogle Scholar
  82. 82.
    Kato Y, Ferguson TB, Bennett DE, Burford TH (1969) Oat cell carcinoma of the lung: a review of 138 cases. Cancer 23(3):517–524CrossRefPubMedGoogle Scholar
  83. 83.
    Shepherd FA, Laskey J, Evans WK, Goss PE, Johansen E, Khamsi F (1992) Cushing’s syndrome associated with ectopic corticotropin production and small-cell lung cancer. J Clin Oncol 10(1):21–27CrossRefPubMedGoogle Scholar
  84. 84.
    Howlett TA, Rees LH, Besser GM (1985) Cushing’s syndrome. Clin Endocrinol Metab 14(4):911–945CrossRefPubMedGoogle Scholar
  85. 85.
    Kanaji N, Watanabe N, Kita N, Bandoh S, Tadokoro A, Ishii T et al (2014) Paraneoplastic syndromes associated with lung cancer. World J Clin Oncol 5(3):197–223CrossRefPubMedPubMedCentralGoogle Scholar
  86. 86.
    Small M, Lowe GD, Forbes CD, Thomson JA (1983) Thromboembolic complications in Cushing’s syndrome. Clin Endocrinol 19(4):503–511CrossRefGoogle Scholar
  87. 87.
    Jeong C, Lee J, Ryu S, Lee HY, Shin AY, Kim JS et al (2015) A case of ectopic adrenocorticotropic hormone syndrome in small cell lung cancer. Tuberc Respir Dis 78(4):436–439CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department EndocrinologyHospital Universitario de la PrincesaMadridSpain
  2. 2.Department EndocrinologyHospital Universitario Rey Juan CarlosMadridSpain

Personalised recommendations