Ectopic ACTH Secretion (EAS) Associated to a Well-Differentiated Peritoneal Mesothelioma

Case Report

Carmen F. Mendoza; Patricia Ontiveros; Daniel X. Xibillé; Manuel H. Rivera


BMC Endocr Disord. 2015;15(40) 

In This Article


The differential diagnosis between Cushing's disease and ectopic secretion of ACTH is a challenge. The case presented here is a rare example of those reaching a suppression percentage with HDDST which was similar to Cushing's disease. Most authors have found, and statistics confirm this, that with suppression percentages over 80 %, the probability that the origin of Cushing's syndrome is a tumor is very high. When MRI is repeatedly normal, as in the case here presented, the best diagnostic test is an inferior petrosal sinus catheterization. This test was performed in our patient 13 years prior in a tertiary care center and, although we were not able to review the results, the patient did not undergo pituitary surgery and was only followed in the outpatient clinic, leading us to assume that the result reflected ectopic secretion without localizing the origin of the secretion at that time because the clinical course of the patient had been insidious, presenting new symptoms and signs more than 20 years after the onset of the first clinical manifestations, which differs from most non-pituitary ACTH-producing tumors, whose development is faster and more aggressive.