FUNCTIONING ISLET-CELL CARCINOMA OF THE PANCREAS WITH CUSHING'S SYNDROME

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Abstract
An unusual case of Cushing's syndrome associated with a functioning isletcell carcinoma of the pancreas in a 36-year-old woman is presented. The patient had the moon facies, hypertension and striae of Cushing's syndrome, with a right upper abdominal mass and an elevated 17-ketosteroid excretion of 28.1 mg. per twenty-four hours. At operation a large mass was found, which at the time was presumed to be of right adrenal origin; local and hepatic metastases were present. Biopsy of the mass revealed poorly differentiated carcinoma. Postoperatively hypoglycemia developed and progressed in severity to the point of constant convulsions and death in spite of large amounts of glucose orally and intravenously. During this postoperative period, the urinary excretion of adrenal steroids increased markedly and the blood insulin level was five to ten times the normal value. Instead of adrenal carcinoma, marked adrenal hyperplasia was found at necropsy, associated with an islet-cell carcinoma of the pancreas.