Ectopic Acth-Secreting Syndrome: A Single-Center Experience

Kakade, Harshal; Kasaliwal, Rajeev; Jagtap, Varsha S.; Bukan, Amol; Budyal, Sweta; Khare, Shruti; Lila, Anurag; Bandgar, Tushar; Menon, P. S. N.; Shah, Nalini

doi:10.4158/ep13171.or

Cited by 33 publications

(33 citation statements)

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“…Twelve patients diagnosed as EAS were included in the study (none of these patients had been a part of our previously published cohort) (17). The diagnosis of EAS was established after a stepwise evaluation as described previously (17).…”

Section: Methodsmentioning

confidence: 99%

Comparison of 68Ga-DOTANOC PET/CT and contrast-enhanced CT in localisation of tumours in ectopic ACTH syndrome

Goroshi

Jadhav

Lila

et al. 2016

Endocrine Connections

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BackgroundLocalising ectopic adrenocorticotrophic hormone (ACTH) syndrome (EAS) tumour source is challenging. Somatostatin receptor-based PET imaging has shown promising results, but the data is limited to case reports and small case series. We reviewed here the performance of 68Ga-DOTANOC positron emission tomography (PET)/computed tomography (CT) and contrast-enhanced CT (CECT) in our cohort of 12 consecutive EAS patients.Materials and methodsRetrospective data analysis of 12 consecutive patients of EAS presenting to a single tertiary care centre in a period between January 2013 and December 2014 was done. CECT and 68Ga-DOTANOC PET/CT were reported (blinded) by an experienced radiologist and a nuclear medicine physician, respectively. The performance of CECT and 68Ga-DOTANOC PET/CT was compared.ResultsTumours could be localised in 11 out of 12 patients at initial presentation (overt cases), whereas in one patient, tumour remained occult. Thirteen lesions were identified in 11 patients as EAS source (true positives). CECT localised 12 out of these 13 lesions (sensitivity 92.3%) and identified five false-positive lesions (positive predictive value (PPV) 70.5%). Compared with false-positive lesions, true-positive lesions had greater mean contrast enhancement at 60s (33.2 vs 5.6 Hounsfield units (HU)). 68Ga-DOTANOC PET/CT was able to identify 9 out of 13 lesions (sensitivity 69.2%) and reported no false-positive lesions (PPV 100%).ConclusionCECT remains the first-line investigation in localisation of EAS. The contrast enhancement pattern on CECT can further aid in characterisation of the lesions. 68Ga-DOTANOC PET/CT can be added to CECT, to enhance positive prediction of the suggestive lesions.

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Section: Methodsmentioning

confidence: 99%

Comparison of 68Ga-DOTANOC PET/CT and contrast-enhanced CT in localisation of tumours in ectopic ACTH syndrome

Goroshi

Jadhav

Lila

et al. 2016

Endocrine Connections

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“…In the study of Venkitaraman et al, three patients with well-differentiated lung neuroendocrine tumors (typical carcinoids) were negative at FDG PET and positive at SSTR-PET [28]. In the study of Kakade et al, one patient with bronchial carcinoid, one with pancreatic neuroendocrine tumor, and two with medullary thyroid cancer had both FDG-and SSTR-PET-positive findings [30].…”

Section: Comparative Analysis Of the Different Tracers And Modalitiesmentioning

confidence: 97%

“…In the study of Ozkan et al, one lung neuroendocrine tumor was identified by 68 Ga-DOTATATE PET/ CT which the CT of the thorax could not detect [31]. About the 4 tumors detected by PET as source of ectopic Cushing syndrome in the study by Kakade et al, only two of them were already localized by CT [30]. In the study by Xu et al, the lesions detected by 18 F-FDG PET/CT were missed by previous CT imaging, whereas in the prospective study by Zemskova et al, the sensitivity of CT in detecting to source of ectopic Cushing syndrome was superior compared to that of 18 F-FDG and 18 F-DOPA PET (68 vs. 50 % and 46, respectively) [34,36].…”

Section: Comparative Analysis Of the Different Tracers And Modalitiesmentioning

confidence: 98%

“…In a Japanese single-center study, all 4 patients with Cushing syndrome who underwent 18 F-FDG PET had ectopic ACTH-secreting tumors detected by this imaging method [30].…”

Section: F-fdgmentioning

confidence: 99%

“…One additional study was found screening the references of the selected articles (8). Finally, 13 articles encompassing 77 patients with ectopic ACTH-secreting tumors who underwent PET imaging were selected for the systematic review [8,15,[27][28][29][30][31][32][33][34][35][36][37] (Fig. 1).…”

Section: Literature Searchmentioning

confidence: 99%

See 2 more Smart Citations

PET imaging in ectopic Cushing syndrome: a systematic review

et al. 2015

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Cushing syndrome due to endogenous hypercortisolism may cause significant morbidity and mortality. The source of excess cortisol may be adrenal, pituitary, or ectopic. Ectopic Cushing syndrome is sometimes difficult to localize on conventional imaging like CT and MRI. After performing a multilevel thoracoabdominal imaging with CT, the evidence regarding the use of radiotracers for PET imaging is unclear due to significant molecular and etiological heterogeneity of potential causes of ectopic Cushing's syndrome. In our systematic review of literature, it appears that GalLium-based (Ga68) somatostatin receptor analogs have better sensitivity in diagnosis of bronchial carcinoids causing Cushing syndrome and FDG PET appears superior for small-cell lung cancers and other aggressive tumors. Further large-scale studies are needed to identify the best PET tracer for this condition.

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Venous Intracranial Interventions

Boddu

Patsalides

2018

Textbook of Catheter-Based Cardiovascular Interventions

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Ectopic Acth-Secreting Syndrome: A Single-Center Experience

Cited by 33 publications

References 11 publications

Comparison of 68Ga-DOTANOC PET/CT and contrast-enhanced CT in localisation of tumours in ectopic ACTH syndrome

Comparison of 68Ga-DOTANOC PET/CT and contrast-enhanced CT in localisation of tumours in ectopic ACTH syndrome

PET imaging in ectopic Cushing syndrome: a systematic review

Venous Intracranial Interventions

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