Evidence for ectopic ACTH production years after bilateral adrenalectomy for Cushing’s syndrome: in vivo and in vitro studies
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Three patients presented with hyperpigmentation and high plasma levels of ACTH 4–5 years after bilateral adrenalectomy for Cushing’s “disease”. X-rays and ct-scan of the lungs showed a small pulmonary mass in all. ACTH levels (1100–2000 pg/ml) were notsuppressibile by high doses hydrocortisone. A carcinoid tumor was removed in two cases and a chemodectoma in the third. Evidence for ACTH secretion by these tumors was provided by both decrease of ACTH levels after surgery and/or in vitro studies. Both carcinoid cultures showed a basal ACTH production, which was clearly increased by LVP (10−7 M) and CRF (10−7 M). Our findings in in vitro studies suggest the presence of specific receptor sites for physiological stimuli (LVP and CRF) in tumor cell membranes.
Key-wordsCushing’s syndrome ACTH ectopic production
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