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01.12.2015 | Case report | Ausgabe 1/2015 Open Access

BMC Endocrine Disorders 1/2015

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

Zeitschrift:
BMC Endocrine Disorders > Ausgabe 1/2015
Autoren:
Carmen F. Mendoza, Patricia Ontiveros, Daniel X. Xibillé, Manuel H. Rivera
Wichtige Hinweise
Carmen F. Mendoza and Daniel X. Xibillé contributed equally to this work.
An erratum to this article can be found at http://​dx.​doi.​org/​10.​1186/​s12902-015-0046-x.
An erratum to this article is available at http://​dx.​doi.​org/​10.​1186/​s12902-015-0046-x.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

CFM: Participated in the supervision of case management, carried out the patient history, relevant examination and review of the patient and writing of the manuscript. PO: Histopathology analysis. DXX: Participated in writing and translating the manuscript, including final proof reading. All authors read and approved the final manuscript.

Abstract

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.
Literatur
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