Adrenal-pituitary Studies in a Patient with Bronchogenic Carcinoma and Cushing's Syndrome

Publisher Website
Google Scholar
Abstract
An association between bronchogenic carcinoma and Cushing''s syndrome has recently been recognized. The patient''s already elevated plasma and urinary 17-OHCS levels did not significantly rise with ACTH stimulation. The patient also failed to show a normal circadian variation in plasma 17-OHCS levels. Dexamethasone administration apparently decreased his urinary secretion of 17-OHCS; however, control studies performed a week after the suppression test showed a still further decrease in corticoid excretion. Baseline plasma and urinary 11-desoxycorticosteroid (11-DOCS) levels were elevated. A normal increase in 11-DOCS followed a standardized methopyrapone infusion test. Paper chromatography showed increased amounts of tetrahydro S in the control urine. This raised the possibility that the patient''s anabolic cortisol pathway was overloaded with a relative deficiency of 11B-hydroxylase present before methopyrapone (Metopirone) infusion. Increased ACTH-like activity was found in the primary tumor and hepatic metastases. Elevated levels of ACTH-like activity were also present in the patient''s plasma and pituitary ACTH activity was decreased. The data from this case seem most consistent with the hypothesis that the patient''s bronchogenic carcinoma was secreting an ACTH-like substance which resulted in excess adrenal cortical activity.

This publication has 18 references indexed in Scilit: