A rare case of Cushing syndrome ectopic-ACTH: A case report

Malignant tumors, nevertheless, have been associated with extremely high circulating ACTH and cortisol levels, and short duration of symptoms of Cushing syndrome (CS) besides atypical clinical phenotype, when compared with pituitary-dependent Cushing. A 33-year-old woman with a history of insulin-induced diabetes admitted to our department for suspicion of ACTH-dependent Cushing's syndrome held in front of : a Cushing's syndrome clinic, biological Cushing's syndrome, CLU : 2894ug/24h, minute braking : negative, cortisolemia 32.1ug/dl, ACTH : 232ng/l, CT scan of the adrenal glands in favor of moderate adrenal hyperplasia. MRI Pituitary without anomaly, strong negative braking. An Octreoscan objectified the presence of two thyroid nodules of hypodense generation moderately fixing the radiotracer, measuring respectively 1.9*1.2cm on the right and 1.5*1.1cm on the left. The focus intensely fixes the retrotracheal radiotracer and the right paravertebral retrotracer. Tumor markers are negative. The patient was operated on for anopathy : thyroid nodular dystrophy, reactive lymphadenitis, a review of the anopathy with iminohistochemistry is requested results in progress. The patient comes to our training 1 month post-operative, the patient reports a regular cycle return, the clinical examination shows a disappearance of purple stretch marks and bruises. Control octreoscan shows the absence of signs in favor of a neuroendocrine tumor at the pleuro-pulmonary, digestive or thyroid level. The nodule resected to objective the presence of anti-ACTH antibodies in immunohistochemistry. . Identification of the source of ACTH can be challenging, as sometimes the primary lesion is not identified even after prolonged and repeated follow-up.