Ectopic Cushings syndrome management A case report

Abstract

Title of the abstract Ectopic Cushings syndrome management A case report. Department General Surgery. Name of the candidate Philip Mitta Degree and subject M.S. General Surgery. Ectopic Cushings syndrome (CS) is a  condition where excess endogenous cortisol secretion occurs by a non-pituitary tumour. A case report of such an ectopic ACTH sectrting tumour has been discussed along with its management. A 19 year old medical student presented with history of swelling of lower limbs and face, weight gain,   proximal muscle weakness in the lower limbs, polyuria and episodic violent behavior along with uncontrolled                    hypertension. He was being treated symptomatically for all his symptoms. An imaging of the chest revealed a thymoma for which he had undergone a thymectomy. Only a near total excision of the thymus was possible due to adherence to the innominate vein. Following the operation, his symptoms  persisted. A bilateral adrenalectomy was planned to achieve control of the hypercortesolemic state. Discussion Ectopic sectretion of ACTH constitutes 10-15 percent of all the causes of Cushings syndrome. Such tumours secrete a     disproportionately greater amount of ACTH and have an   aggressive course. Conclusion Retroperitoneoscopic bilateral adrenalectomy is a safe and feasible option for patients with ectopic Cushings syndrome who are not relieved in spite of primary surgery or are at risk of a life -threatening   immunocompromised state with sepsis.