The Cushing syndrome induced by bronchial carcinoid tumors

Andrew Harold Limper, Paul C. Carpenter, Bernd Scheithauer, Bruce A. Staats

Research output: Contribution to journalArticle

117 Citations (Scopus)

Abstract

Objectives: To define the clinical spectrum of bronchial carcinoid tumors in patients presenting with the Cushing syndrome, to evaluate the role of chest radiographs and computed tomography in their diagnosis, to review the characteristic histologic features, and to determine patient outcome. Design: Retrospective analysis of consecutive patients. Setting: A referral-based medical center. Patients: Fifteen consecutive patients with the Cushing syndrome evaluated at the Mayo Clinic with histologically proven bronchial carcinoid tumors. Measurements: Clinical, radiographic, and histologic features. Results: The Cushing syndrome was the initial clinical presentation, and bronchial carcinoid tumors were found later in all 15 patients. The diagnosis of carcinoid tumor was proved histologically in all cases. Ten biopsies showed typical carcinoid tumors, three were histologically atypical, and three were metastatic. Corticotropin was detected by immunostaining in seven of these tumors. Biochemical analysis showed marked elevations of circulating corticotropin with a mean serum value of 156 ± 58 pmol/L (normal, 4 to 22 pmol/L). Additional clinical features included hypokalemia in six patients and glucocorticoid response to either high-dose dexamethasone or metyrapone in 6 of 13. These hormonally active carcinoid tumors were frequently radiographically occult, with 10 of 15 patients initially having normal chest radiographs. Computed tomography was successful in locating carcinoid tumors in five patients with negative chest radiographs evaluated after 1980. All five remaining patients with normal chest radiographs evaluated before 1980 eventually developed nodular lesions on standard chest radiography from 1 to 10 years later. Ten patients achieved complete remission and two patients, partial remission of the Cushing syndrome after surgical resection. Three patients continued to have symptomatic glucocorticoid excess due to metastatic disease. Conclusions: Although uncommon, the Cushing syndrome may be the initial clinical manifestation of an otherwise indolent bronchial carcinoid tumor. Radiographic imaging of occult lesions can be successfully accomplished with computed tomography. Surgical resection is curative in most patients with this disorder.

Original languageEnglish (US)
Pages (from-to)209-214
Number of pages6
JournalAnnals of Internal Medicine
Volume117
Issue number3
StatePublished - Aug 1 1992

Fingerprint

Cushing Syndrome
Carcinoid Tumor
Thorax
Tomography
Adrenocorticotropic Hormone
Glucocorticoids
Metyrapone
Hypokalemia
Radiography
Dexamethasone

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Limper, A. H., Carpenter, P. C., Scheithauer, B., & Staats, B. A. (1992). The Cushing syndrome induced by bronchial carcinoid tumors. Annals of Internal Medicine, 117(3), 209-214.

The Cushing syndrome induced by bronchial carcinoid tumors. / Limper, Andrew Harold; Carpenter, Paul C.; Scheithauer, Bernd; Staats, Bruce A.

In: Annals of Internal Medicine, Vol. 117, No. 3, 01.08.1992, p. 209-214.

Research output: Contribution to journalArticle

Limper, AH, Carpenter, PC, Scheithauer, B & Staats, BA 1992, 'The Cushing syndrome induced by bronchial carcinoid tumors', Annals of Internal Medicine, vol. 117, no. 3, pp. 209-214.
Limper AH, Carpenter PC, Scheithauer B, Staats BA. The Cushing syndrome induced by bronchial carcinoid tumors. Annals of Internal Medicine. 1992 Aug 1;117(3):209-214.
Limper, Andrew Harold ; Carpenter, Paul C. ; Scheithauer, Bernd ; Staats, Bruce A. / The Cushing syndrome induced by bronchial carcinoid tumors. In: Annals of Internal Medicine. 1992 ; Vol. 117, No. 3. pp. 209-214.
@article{88edd3f7b0a0460ebdb25f352a6504a1,
title = "The Cushing syndrome induced by bronchial carcinoid tumors",
abstract = "Objectives: To define the clinical spectrum of bronchial carcinoid tumors in patients presenting with the Cushing syndrome, to evaluate the role of chest radiographs and computed tomography in their diagnosis, to review the characteristic histologic features, and to determine patient outcome. Design: Retrospective analysis of consecutive patients. Setting: A referral-based medical center. Patients: Fifteen consecutive patients with the Cushing syndrome evaluated at the Mayo Clinic with histologically proven bronchial carcinoid tumors. Measurements: Clinical, radiographic, and histologic features. Results: The Cushing syndrome was the initial clinical presentation, and bronchial carcinoid tumors were found later in all 15 patients. The diagnosis of carcinoid tumor was proved histologically in all cases. Ten biopsies showed typical carcinoid tumors, three were histologically atypical, and three were metastatic. Corticotropin was detected by immunostaining in seven of these tumors. Biochemical analysis showed marked elevations of circulating corticotropin with a mean serum value of 156 ± 58 pmol/L (normal, 4 to 22 pmol/L). Additional clinical features included hypokalemia in six patients and glucocorticoid response to either high-dose dexamethasone or metyrapone in 6 of 13. These hormonally active carcinoid tumors were frequently radiographically occult, with 10 of 15 patients initially having normal chest radiographs. Computed tomography was successful in locating carcinoid tumors in five patients with negative chest radiographs evaluated after 1980. All five remaining patients with normal chest radiographs evaluated before 1980 eventually developed nodular lesions on standard chest radiography from 1 to 10 years later. Ten patients achieved complete remission and two patients, partial remission of the Cushing syndrome after surgical resection. Three patients continued to have symptomatic glucocorticoid excess due to metastatic disease. Conclusions: Although uncommon, the Cushing syndrome may be the initial clinical manifestation of an otherwise indolent bronchial carcinoid tumor. Radiographic imaging of occult lesions can be successfully accomplished with computed tomography. Surgical resection is curative in most patients with this disorder.",
author = "Limper, {Andrew Harold} and Carpenter, {Paul C.} and Bernd Scheithauer and Staats, {Bruce A.}",
year = "1992",
month = "8",
day = "1",
language = "English (US)",
volume = "117",
pages = "209--214",
journal = "Annals of Internal Medicine",
issn = "0003-4819",
publisher = "American College of Physicians",
number = "3",

}

TY - JOUR

T1 - The Cushing syndrome induced by bronchial carcinoid tumors

AU - Limper, Andrew Harold

AU - Carpenter, Paul C.

AU - Scheithauer, Bernd

AU - Staats, Bruce A.

PY - 1992/8/1

Y1 - 1992/8/1

N2 - Objectives: To define the clinical spectrum of bronchial carcinoid tumors in patients presenting with the Cushing syndrome, to evaluate the role of chest radiographs and computed tomography in their diagnosis, to review the characteristic histologic features, and to determine patient outcome. Design: Retrospective analysis of consecutive patients. Setting: A referral-based medical center. Patients: Fifteen consecutive patients with the Cushing syndrome evaluated at the Mayo Clinic with histologically proven bronchial carcinoid tumors. Measurements: Clinical, radiographic, and histologic features. Results: The Cushing syndrome was the initial clinical presentation, and bronchial carcinoid tumors were found later in all 15 patients. The diagnosis of carcinoid tumor was proved histologically in all cases. Ten biopsies showed typical carcinoid tumors, three were histologically atypical, and three were metastatic. Corticotropin was detected by immunostaining in seven of these tumors. Biochemical analysis showed marked elevations of circulating corticotropin with a mean serum value of 156 ± 58 pmol/L (normal, 4 to 22 pmol/L). Additional clinical features included hypokalemia in six patients and glucocorticoid response to either high-dose dexamethasone or metyrapone in 6 of 13. These hormonally active carcinoid tumors were frequently radiographically occult, with 10 of 15 patients initially having normal chest radiographs. Computed tomography was successful in locating carcinoid tumors in five patients with negative chest radiographs evaluated after 1980. All five remaining patients with normal chest radiographs evaluated before 1980 eventually developed nodular lesions on standard chest radiography from 1 to 10 years later. Ten patients achieved complete remission and two patients, partial remission of the Cushing syndrome after surgical resection. Three patients continued to have symptomatic glucocorticoid excess due to metastatic disease. Conclusions: Although uncommon, the Cushing syndrome may be the initial clinical manifestation of an otherwise indolent bronchial carcinoid tumor. Radiographic imaging of occult lesions can be successfully accomplished with computed tomography. Surgical resection is curative in most patients with this disorder.

AB - Objectives: To define the clinical spectrum of bronchial carcinoid tumors in patients presenting with the Cushing syndrome, to evaluate the role of chest radiographs and computed tomography in their diagnosis, to review the characteristic histologic features, and to determine patient outcome. Design: Retrospective analysis of consecutive patients. Setting: A referral-based medical center. Patients: Fifteen consecutive patients with the Cushing syndrome evaluated at the Mayo Clinic with histologically proven bronchial carcinoid tumors. Measurements: Clinical, radiographic, and histologic features. Results: The Cushing syndrome was the initial clinical presentation, and bronchial carcinoid tumors were found later in all 15 patients. The diagnosis of carcinoid tumor was proved histologically in all cases. Ten biopsies showed typical carcinoid tumors, three were histologically atypical, and three were metastatic. Corticotropin was detected by immunostaining in seven of these tumors. Biochemical analysis showed marked elevations of circulating corticotropin with a mean serum value of 156 ± 58 pmol/L (normal, 4 to 22 pmol/L). Additional clinical features included hypokalemia in six patients and glucocorticoid response to either high-dose dexamethasone or metyrapone in 6 of 13. These hormonally active carcinoid tumors were frequently radiographically occult, with 10 of 15 patients initially having normal chest radiographs. Computed tomography was successful in locating carcinoid tumors in five patients with negative chest radiographs evaluated after 1980. All five remaining patients with normal chest radiographs evaluated before 1980 eventually developed nodular lesions on standard chest radiography from 1 to 10 years later. Ten patients achieved complete remission and two patients, partial remission of the Cushing syndrome after surgical resection. Three patients continued to have symptomatic glucocorticoid excess due to metastatic disease. Conclusions: Although uncommon, the Cushing syndrome may be the initial clinical manifestation of an otherwise indolent bronchial carcinoid tumor. Radiographic imaging of occult lesions can be successfully accomplished with computed tomography. Surgical resection is curative in most patients with this disorder.

UR - http://www.scopus.com/inward/record.url?scp=0026721228&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0026721228&partnerID=8YFLogxK

M3 - Article

VL - 117

SP - 209

EP - 214

JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

SN - 0003-4819

IS - 3

ER -