Is ectopic Cushing’s syndrome underdiagnosed in patients with small cell lung cancer?

Piasecka, Marta; Larsson, Martin; Papakokkinou, Eleni; Olsson, Lena; Ragnarsson, Oskar

doi:10.3389/fmed.2022.954033

Cited by 4 publications

(2 citation statements)

References 24 publications

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“…Small cell lung cancer has been reported to exhibit endocrine abnormalities. A study of 213 cases of small cell lung cancer found that the condition in one case was complicated and that in two cases was likely complicated with Cushing's syndrome associated with ectopic adrenocorticotropic hormone (ACTH) production (Piasecka et al 2022 ). Hypothyroidism and menstrual dysfunction associated with ectopic ACTH-producing tumors are reported to improve after drug treatment (Lin et al 2009 ).…”

Section: Discussionmentioning

confidence: 99%

Association between PET–CT accumulation in the hypothalamic/pituitary regions and neuron-specific enolase/primary tumor in limited-stage small cell lung cancer: a case-controlled retrospective study

Okada,

Zama,

Itonaga

et al. 2024

EJNMMI Rep.

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Background Research on the relationship between neuron-specific enolase (NSE) levels and normal organs, particularly the central nervous system, in small cell lung cancer is limited. Therefore, this study aimed to investigate the relationship between positron emission tomography–computed tomography (PET–CT) accumulation at hypothalamic/pituitary regions, tumor activity, and NSE level in limited-stage small cell lung cancer. We retrospectively analyzed patients who were diagnosed with limited-stage small cell lung cancer at Tokyo Medical University Hospital between July 1, 2019, and May 31, 2023, and were treated with chemoradiotherapy or radiotherapy. Leukocytes, erythrocytes, hemoglobin, platelets, total protein, albumin, NSE, and carcinoembryonic antigen were measured in blood samples obtained before treatment initiation. The maximum standardized uptake value (SUVmax), volume, and total lesion glycolysis (TLG) of each hypothalamic /pituitary region, primary tumor, and lymph node metastases were extracted from PET–CT images. The total tumor volume (primary tumor volume plus lymph node metastases volume) and total TLG (primary tumor TLG plus lymph node metastases TLG) were calculated. Results This study included 19 patients (mean age, 70.1 ± 8.8 years; 13 men and 6 women); the pathology in all patients was small cell lung cancer. Patients were classified into two groups according to the NSE reference value (16.3 ng/mL): six patients having NSE level below the reference value and 13 having NSE level above the reference value. The SUVmax in the hypothalamic/pituitary region was 2.95 in the NSE < 16.3 ng/mL group and 4.10 in the NSE > 16.3 ng/mL group, with a statistically significant difference (p = 0.03). The total tumor volume was 17.8 mL in the NSE < 16.3 ng/mL group and 98.9 mL in the NSE > 16.3 ng/mL group, with a statistically significant difference (p < 0.01). A correlation coefficient of r = 0.458 (p = 0.0486) was observed between SUVmax in the hypothalamus/pituitary and NSE level. A correlation coefficient of r = 0.647 (p < 0.01) was also observed between total tumor volume and NSE level. Finally, a correlation coefficient of r = 0.53 (p = 0.01) was observed between hypothalamic/pituitary TLG and primary tumor TLG. Conclusions The findings demonstrated a correlation between hypothalamic/pituitary activity and tumor activity, suggesting the prognostic significance of NSE.

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Section: Discussionmentioning

confidence: 99%

Association between PET–CT accumulation in the hypothalamic/pituitary regions and neuron-specific enolase/primary tumor in limited-stage small cell lung cancer: a case-controlled retrospective study

Okada,

Zama,

Itonaga

et al. 2024

EJNMMI Rep.

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“…Small cell lung cancer has been reported to exhibit endocrine abnormalities. It was reported that in 213 cases of small cell lung cancer, one case was complicated and two cases were likely complicated with Cushing's syndrome associated with ectopic adrenocorticotropic hormone (ACTH)-stimulating hormone [14]. It has also been reported that hypothyroidism and menstrual dysfunction associated with ectopic ACTH-producing tumors improved after drug treatment [15].…”

Section: Discussionmentioning

confidence: 99%

Association between PET-CT accumulation in the hypothalamic /pituitary regions and neuron-specific enolase /primary tumor in limited-stage small cell lung cancer

Okada,

Zama,

Itonaga

et al. 2023

Preprint

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Objective: This study aimed to investigate the relationship between positron emission tomography-computed tomography (PET-CT) accumulation at hypothalamic /pituitary regions, tumor, and neuron-specific enolase (NSE) in limited-stage small cell lung cancer. Methods: We analyzed patients who were diagnosed with limited-stage small cell lung cancer at Tokyo Medical University Hospital between July 1, 2019 and May 31, 2023 and who underwent chemoradiotherapy or radiotherapy. Leukocytes, erythrocytes, hemoglobin, platelets, total protein, albumin, NSE, and carcinoembryonic antigen were measured in blood samples taken before the start of treatment. In PET-CT, the maximum standardized uptake value (SUVmax), volume. total lesion glycolysis (TLG) of the hypothalamic /pituitary regions, primary tumor, lymph node metastases were extracted. And total tumor volume (primary tumor and lymph node metastases), total TLG (primary tumor and lymph node metastases) were calculated. Results: A total of 19 patients were selected (mean age 70.1±8.8 years; 13 male and six female). The pathology of all cases was small cell lung cancer. Cases were classified into two groups according to the NSE standard value (16.3 ng/mL); six cases were below the standard value and 13 were above the standard value. The SUVmax in the hypothalamic/pituitary region was 2.95 in the NSE <16.3ng/mL group and 4.10 in the NSE >16.3ng/mL group, showing a statically significant difference (p=0.03).The total tumor volume was 17.8 ml in the NSE <16.3ng/mL group and 98.9 ml in the NSE >16.3ng/mL group, showing a statically significant difference (p<0.01).A correlation coefficient of r=0.458 and p=0.0486 was observed between SUVmax in the hypothalamus/pituitary and NSE. A correlation coefficient of r=0.647 and p<0.01 was observed between total tumor volume and NSE. A correlation coefficient of r=0.53 and p=0.01 was observed between hypothalamic/pituitary TLG and primary tumor TLG. Conclusions: There was correlation between hypothalamic/pituitary activity and tumor activity.

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Ectopic ACTH Syndrome: Possibilities of Modern Diagnostics

Grineva,

Tsoy,

Ryzhkova

2024

Annals RAMS

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The ectopic ACTH syndrome (EAS) is a constellation of clinical signs and symptoms caused by chronic excess production of cortisol by the adrenal glands due to stimulation by adrenocorticotropic hormone (ACTH) of extrapituitary origin. EAS is a rare pathology, it accounts for approximately 20% of all cases of ACTH-dependent hypercortisolism and up to 10% of all causes of endogenous autonomic cortisol production, however, it is often associated with severe hypercortisolism and is a life-threatening condition. The sources of ectopic secretion of ACTH are neuroendocrine tumors (NET), which differ in histological type, malignant potential, clinical course, and also have different, often difficult to detect localization. Early identification of ACTH -producing NET reduces the risk of death of the patient both from severe hypercortisolism and the tumor itself. The paper describes the features of the course of EAS, the possibilities of its diagnosis, and presents an algorithm for EAS diagnosis, created on the basis of the latest achievements of Russian and world medicine.

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Is ectopic Cushing’s syndrome underdiagnosed in patients with small cell lung cancer?

Cited by 4 publications

References 24 publications

Association between PET–CT accumulation in the hypothalamic/pituitary regions and neuron-specific enolase/primary tumor in limited-stage small cell lung cancer: a case-controlled retrospective study

Association between PET–CT accumulation in the hypothalamic/pituitary regions and neuron-specific enolase/primary tumor in limited-stage small cell lung cancer: a case-controlled retrospective study

Association between PET-CT accumulation in the hypothalamic /pituitary regions and neuron-specific enolase /primary tumor in limited-stage small cell lung cancer

Ectopic ACTH Syndrome: Possibilities of Modern Diagnostics

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