Management of the ectopic ACTH syndrome due to thoracic carcinoids

Harvey I. Pass, John L. Doppman, Lynnette Nieman, Mark Stovroff, John Vetto, Jeffrey A. Norton, William Travis, George P. Chrousos, Edward H. Oldfield, Gordon B. Cutler

Research output: Contribution to journalArticle

80 Citations (Scopus)

Abstract

The association of a bronchial or thymic carcinoid as a source for the ectopic production of adrenocorticotropic hormone (ACTH) has been reported since 1957, with approximately 72 cases in the literature. These patients are characterized by young age, long duration of Cushing's syndrome because of the inability to find the ectopic source, and a high incidence of hypophysectomy or adrenalectomy without curing the disease. A substantial number of patients, upon discovery of the thoracic ectopic source, are also found to have malignant carcinoid tumors with lymph node metastases. Fifteen patients have been explored for a presumed intrathoracic source of ACTH at our institution since 1983 and 14 carcinoids (13 bronchial, one thymic) have been resected. Seventy-one percent ( 10 14) of the patients appear cured with normal plasma ACTH levels 5 to 57 months after resection, despite a 50% incidence of positive lymph node disease. Management of these patients demands an aggressive evaluation to prevent unnecessary adrenalectomy or hypophysectomy and to allow earlier resections before these potentially curable malignancies metastasize. When the tumor is discovered, thorough exploration and complete lymph node mapping with resection must be performed.

Original languageEnglish (US)
Pages (from-to)52-57
Number of pages6
JournalThe Annals of Thoracic Surgery
Volume50
Issue number1
DOIs
StatePublished - 1990
Externally publishedYes

Fingerprint

Paraneoplastic Endocrine Syndromes
Carcinoid Tumor
Adrenocorticotropic Hormone
Thorax
Hypophysectomy
Lymph Nodes
Adrenalectomy
Cushing Syndrome
Incidence
Neoplasms
Neoplasm Metastasis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Pass, H. I., Doppman, J. L., Nieman, L., Stovroff, M., Vetto, J., Norton, J. A., ... Cutler, G. B. (1990). Management of the ectopic ACTH syndrome due to thoracic carcinoids. The Annals of Thoracic Surgery, 50(1), 52-57. https://doi.org/10.1016/0003-4975(90)90085-K

Management of the ectopic ACTH syndrome due to thoracic carcinoids. / Pass, Harvey I.; Doppman, John L.; Nieman, Lynnette; Stovroff, Mark; Vetto, John; Norton, Jeffrey A.; Travis, William; Chrousos, George P.; Oldfield, Edward H.; Cutler, Gordon B.

In: The Annals of Thoracic Surgery, Vol. 50, No. 1, 1990, p. 52-57.

Research output: Contribution to journalArticle

Pass, HI, Doppman, JL, Nieman, L, Stovroff, M, Vetto, J, Norton, JA, Travis, W, Chrousos, GP, Oldfield, EH & Cutler, GB 1990, 'Management of the ectopic ACTH syndrome due to thoracic carcinoids', The Annals of Thoracic Surgery, vol. 50, no. 1, pp. 52-57. https://doi.org/10.1016/0003-4975(90)90085-K
Pass, Harvey I. ; Doppman, John L. ; Nieman, Lynnette ; Stovroff, Mark ; Vetto, John ; Norton, Jeffrey A. ; Travis, William ; Chrousos, George P. ; Oldfield, Edward H. ; Cutler, Gordon B. / Management of the ectopic ACTH syndrome due to thoracic carcinoids. In: The Annals of Thoracic Surgery. 1990 ; Vol. 50, No. 1. pp. 52-57.
@article{33fb5d76c5e6405ba8e0d74bf4d170a4,
title = "Management of the ectopic ACTH syndrome due to thoracic carcinoids",
abstract = "The association of a bronchial or thymic carcinoid as a source for the ectopic production of adrenocorticotropic hormone (ACTH) has been reported since 1957, with approximately 72 cases in the literature. These patients are characterized by young age, long duration of Cushing's syndrome because of the inability to find the ectopic source, and a high incidence of hypophysectomy or adrenalectomy without curing the disease. A substantial number of patients, upon discovery of the thoracic ectopic source, are also found to have malignant carcinoid tumors with lymph node metastases. Fifteen patients have been explored for a presumed intrathoracic source of ACTH at our institution since 1983 and 14 carcinoids (13 bronchial, one thymic) have been resected. Seventy-one percent ( 10 14) of the patients appear cured with normal plasma ACTH levels 5 to 57 months after resection, despite a 50{\%} incidence of positive lymph node disease. Management of these patients demands an aggressive evaluation to prevent unnecessary adrenalectomy or hypophysectomy and to allow earlier resections before these potentially curable malignancies metastasize. When the tumor is discovered, thorough exploration and complete lymph node mapping with resection must be performed.",
author = "Pass, {Harvey I.} and Doppman, {John L.} and Lynnette Nieman and Mark Stovroff and John Vetto and Norton, {Jeffrey A.} and William Travis and Chrousos, {George P.} and Oldfield, {Edward H.} and Cutler, {Gordon B.}",
year = "1990",
doi = "10.1016/0003-4975(90)90085-K",
language = "English (US)",
volume = "50",
pages = "52--57",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "1",

}

TY - JOUR

T1 - Management of the ectopic ACTH syndrome due to thoracic carcinoids

AU - Pass, Harvey I.

AU - Doppman, John L.

AU - Nieman, Lynnette

AU - Stovroff, Mark

AU - Vetto, John

AU - Norton, Jeffrey A.

AU - Travis, William

AU - Chrousos, George P.

AU - Oldfield, Edward H.

AU - Cutler, Gordon B.

PY - 1990

Y1 - 1990

N2 - The association of a bronchial or thymic carcinoid as a source for the ectopic production of adrenocorticotropic hormone (ACTH) has been reported since 1957, with approximately 72 cases in the literature. These patients are characterized by young age, long duration of Cushing's syndrome because of the inability to find the ectopic source, and a high incidence of hypophysectomy or adrenalectomy without curing the disease. A substantial number of patients, upon discovery of the thoracic ectopic source, are also found to have malignant carcinoid tumors with lymph node metastases. Fifteen patients have been explored for a presumed intrathoracic source of ACTH at our institution since 1983 and 14 carcinoids (13 bronchial, one thymic) have been resected. Seventy-one percent ( 10 14) of the patients appear cured with normal plasma ACTH levels 5 to 57 months after resection, despite a 50% incidence of positive lymph node disease. Management of these patients demands an aggressive evaluation to prevent unnecessary adrenalectomy or hypophysectomy and to allow earlier resections before these potentially curable malignancies metastasize. When the tumor is discovered, thorough exploration and complete lymph node mapping with resection must be performed.

AB - The association of a bronchial or thymic carcinoid as a source for the ectopic production of adrenocorticotropic hormone (ACTH) has been reported since 1957, with approximately 72 cases in the literature. These patients are characterized by young age, long duration of Cushing's syndrome because of the inability to find the ectopic source, and a high incidence of hypophysectomy or adrenalectomy without curing the disease. A substantial number of patients, upon discovery of the thoracic ectopic source, are also found to have malignant carcinoid tumors with lymph node metastases. Fifteen patients have been explored for a presumed intrathoracic source of ACTH at our institution since 1983 and 14 carcinoids (13 bronchial, one thymic) have been resected. Seventy-one percent ( 10 14) of the patients appear cured with normal plasma ACTH levels 5 to 57 months after resection, despite a 50% incidence of positive lymph node disease. Management of these patients demands an aggressive evaluation to prevent unnecessary adrenalectomy or hypophysectomy and to allow earlier resections before these potentially curable malignancies metastasize. When the tumor is discovered, thorough exploration and complete lymph node mapping with resection must be performed.

UR - http://www.scopus.com/inward/record.url?scp=0025292841&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0025292841&partnerID=8YFLogxK

U2 - 10.1016/0003-4975(90)90085-K

DO - 10.1016/0003-4975(90)90085-K

M3 - Article

VL - 50

SP - 52

EP - 57

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 1

ER -