A Case of ACTH-Secreting Bronchial Carcinoid.

Introduction: Ectopic ACTH syndrome (EAS) occurs in about 5-10% of ACTH-dependent hypercortisolism and, in up to 15% of cases, is related to occult neoplasms. Aim(s): We report one case of EAS highlighting the usefulness of Nuclear Medicine imaging in pre- and intraoperative localization of the ACTH-secreting neoplasm. Materials and methods: A 66-year-old male patient was diagnosed in 2010 with ACTH-dependent hypercortisolism. Pituitary MRI was negative, while a chest-abdomen CT scan described a 7-mm nodule in the upper lobe of the right lung. Bilateral Inferior Petrosal Sinus Sampling (BIPSS) showed no evidence of center-periphery ACTH gradient. An Octreoscan did not reveal any area of pathological hyperuptake. Treatment with ketoconazole and lanreotide was started with clinical benefit. In July 2011, the patient underwent a PET/CT scan with 68Ga-DOTANOC that revealed mild hyperuptake of the lung nodule. Results: In September 2011, the patient underwent radio-guided surgery using a hand-held gamma probe 24 h after i.v. administration of 111In-pentetreotide. The pulmonary nodule was identified, confirmed by the gamma probe and surgically removed. Pathology confirmed a typical bronchial carcinoid with positive ACTH expression. Conclusion: This case underlines how the integration of traditional diagnostic tools with both Nuclear Medicine imaging and intraoperative techniques can guarantee an improvement in the diagnostic and therapeutic management of neuroendocrine neoplasms. [ABSTRACT FROM AUTHOR]