Retrospective Analysis Of Ectopic ACTH Syndrome Of 10 Cases

Objective: To improve the understanding and diagnosis of ectopic ACTH syndrome(EAS).Methods: Retrospective analysis was made about 10 patients with ectopic ACTH syndrome admitted to The 4th Hospital of He Bei Medical University from October 2009 to October 2019,on gender,age,course of disease,clinical manifestations,laboratory examination,diagnosis and treatment,etc.SPSS 23 software package was used for statistical analysis,and the measurement data was expressed as((?)± s).Results: Of the 10 patients with EAS,1 was recessive and 9 was dominant.All the 10 patients were first diagnosed with tumors and then diagnosed with EAS during the later treatment period,including 5 males and 5 females.The age of diagnosis was 40-82 years old,with an average age of 55.3 years and a median age of 51 years.The course was 1-156 months,with an average course of 30 months and a median course of 19.5 months.There were 2 cases of small cell lung cancer,1 case of thymoma,1 case of breast cancer,1 case of small cell esophageal cancer,1 case of pancreatic neuroendocrine tumor,1 case of gastric cancer,1 case of prostate cancer,1 case of nasal neuroendocrine cancer,1 case of kidney cancer.Tumors in 5 patients originated in the chest,accounting for 50%.Only the recessive tumor patient showed typical Cushing’s syndrome features such as central obesity,moon face,pigmentation,the rest of 9 dominant tumor patients’ symptoms are not typical,8 cases(80%)with hypertension,10 cases(100%)with high blood sugar,7 cases(70%)with infection,5 cases(50%)with edema.Plasma ACTH increased in all of the 10 patients,cortisol was not measured in 1 patient and increased in the remaining 9,and the circadian rhythm ACTH averaged 498.01±435.74pmol/L at 8:00,and cortisol averaged 1112.01±624.27nmol/L at 8:00.Three patients received high-dose dexamethasone test,and two received low-dose dexamethasone test,all of which were not inhibited.Immunohistochemical staining was performed on the tissue section of 1 patient and ACTH staining was positive.Conclusions: Recessive EAS has typical clinical symptoms of Cushing’s syndrome,such as central obesity,moon face,ecchymosis,pigmentation and so on.Most dominant tumors has no typical clinical symptoms of Cushing’s syndrome,but with some prompt EAS performance,such as intractable hypokalemia,high blood sugar,high blood pressure and edema,etc.Especially intractable hypokalemia is a strong signal for EAS,when Plasma ACTH,cortisol,and the rhythm should be checked.Tumor resection is preferred.If there is no surgical conditions,patients should be treated by chemotherapy,radiotherapy,bilateral adrenal resection and drug treatment.Clinicians should improve the understanding of EAS and strive for early detection,diagnosis and treatment to improve the prognosis of patients.