Neuroendocrine ACTH-producing tumor of the thymus - Experience with 12 patients over 25 years

Nicola M. Neary, Ariel Lopez-Chavez, Brent S. Abel, Alison M. Boyce, Nicholas Schaub, King Kwong, Constantine A. Stratakis, Cesar A. Moran, Giuseppe Giaccone, Lynnette K. Nieman

Research output: Contribution to journalArticle

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Abstract

Context: ACTH-producing neuroendocrine tumor (NET) of the thymus is a rare cause of Cushing's syndrome (CS). The literature consists mainly of isolated case reports. Patients: We studied 12 cases (eight males and four females) diagnosed between 1986 and 2010 with CS and thymic NET who underwent surgical resection. Main Outcome Measures: We measured time from onset of CS to diagnosis of thymic NET, tumor size, histological grade, time to recurrence, and survival and performed a meta-analysis of other published cases of CS associated with thymic NET. Results: Eleven of 12 patients presented with classic features of CS at a median age of 21 yr (range, 7-51). Four were children. The 24-h urine free cortisol was greater than 16-fold of normal, and biochemical testing was consistent with ectopic ACTH production in all 11. Another patient presenting with pulmonary embolus had a thymic mass and was later diagnosed with CS. All patients underwent thymectomy, and nine of 10 tumors exhibited positive ACTH immunochemistry. Median tumor diameter was 5 cm (frange, 1-11.5). Six patients recurred 20-28 months after surgery with metastases to mediastinal lymph nodes (n = 5), bone (n = 5), liver (n = 1), parotid gland (n = 1), and breast (n = 1). Four of five patients treated with radiation therapy also received chemotherapy. All recurrent patients received ketoconazole; four later underwent bilateral adrenalectomy. Six recurrent patients died 22-90 months (median, 57) after thymectomy. At last review, six patients were alive 14-90 months (median, 49) after thymectomy. These data are similar to those from the meta-analysis. Conclusions: Thymic ACTH-producing NET is an aggressive disease that should be considered in CS with ectopic ACTH secretion, particularly in younger patients.

Original languageEnglish (US)
Pages (from-to)2223-2230
Number of pages8
JournalJournal of Clinical Endocrinology and Metabolism
Volume97
Issue number7
DOIs
StatePublished - Jul 2012
Externally publishedYes

Fingerprint

Thymus Neoplasms
Thymus
Adrenocorticotropic Hormone
Tumors
Cushing Syndrome
Neuroendocrine Tumors
Thymectomy
Meta-Analysis
Ketoconazole
Chemotherapy
Radiotherapy
Immunochemistry
Neoplasms
Liver
Surgery
Adrenalectomy
Parotid Gland
Hydrocortisone
Bone
Embolism

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry
  • Endocrinology
  • Biochemistry, medical
  • Endocrinology, Diabetes and Metabolism

Cite this

Neary, N. M., Lopez-Chavez, A., Abel, B. S., Boyce, A. M., Schaub, N., Kwong, K., ... Nieman, L. K. (2012). Neuroendocrine ACTH-producing tumor of the thymus - Experience with 12 patients over 25 years. Journal of Clinical Endocrinology and Metabolism, 97(7), 2223-2230. https://doi.org/10.1210/jc.2011-3355

Neuroendocrine ACTH-producing tumor of the thymus - Experience with 12 patients over 25 years. / Neary, Nicola M.; Lopez-Chavez, Ariel; Abel, Brent S.; Boyce, Alison M.; Schaub, Nicholas; Kwong, King; Stratakis, Constantine A.; Moran, Cesar A.; Giaccone, Giuseppe; Nieman, Lynnette K.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 97, No. 7, 07.2012, p. 2223-2230.

Research output: Contribution to journalArticle

Neary, NM, Lopez-Chavez, A, Abel, BS, Boyce, AM, Schaub, N, Kwong, K, Stratakis, CA, Moran, CA, Giaccone, G & Nieman, LK 2012, 'Neuroendocrine ACTH-producing tumor of the thymus - Experience with 12 patients over 25 years', Journal of Clinical Endocrinology and Metabolism, vol. 97, no. 7, pp. 2223-2230. https://doi.org/10.1210/jc.2011-3355
Neary, Nicola M. ; Lopez-Chavez, Ariel ; Abel, Brent S. ; Boyce, Alison M. ; Schaub, Nicholas ; Kwong, King ; Stratakis, Constantine A. ; Moran, Cesar A. ; Giaccone, Giuseppe ; Nieman, Lynnette K. / Neuroendocrine ACTH-producing tumor of the thymus - Experience with 12 patients over 25 years. In: Journal of Clinical Endocrinology and Metabolism. 2012 ; Vol. 97, No. 7. pp. 2223-2230.
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abstract = "Context: ACTH-producing neuroendocrine tumor (NET) of the thymus is a rare cause of Cushing's syndrome (CS). The literature consists mainly of isolated case reports. Patients: We studied 12 cases (eight males and four females) diagnosed between 1986 and 2010 with CS and thymic NET who underwent surgical resection. Main Outcome Measures: We measured time from onset of CS to diagnosis of thymic NET, tumor size, histological grade, time to recurrence, and survival and performed a meta-analysis of other published cases of CS associated with thymic NET. Results: Eleven of 12 patients presented with classic features of CS at a median age of 21 yr (range, 7-51). Four were children. The 24-h urine free cortisol was greater than 16-fold of normal, and biochemical testing was consistent with ectopic ACTH production in all 11. Another patient presenting with pulmonary embolus had a thymic mass and was later diagnosed with CS. All patients underwent thymectomy, and nine of 10 tumors exhibited positive ACTH immunochemistry. Median tumor diameter was 5 cm (frange, 1-11.5). Six patients recurred 20-28 months after surgery with metastases to mediastinal lymph nodes (n = 5), bone (n = 5), liver (n = 1), parotid gland (n = 1), and breast (n = 1). Four of five patients treated with radiation therapy also received chemotherapy. All recurrent patients received ketoconazole; four later underwent bilateral adrenalectomy. Six recurrent patients died 22-90 months (median, 57) after thymectomy. At last review, six patients were alive 14-90 months (median, 49) after thymectomy. These data are similar to those from the meta-analysis. Conclusions: Thymic ACTH-producing NET is an aggressive disease that should be considered in CS with ectopic ACTH secretion, particularly in younger patients.",
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AU - Schaub, Nicholas

AU - Kwong, King

AU - Stratakis, Constantine A.

AU - Moran, Cesar A.

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AU - Nieman, Lynnette K.

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N2 - Context: ACTH-producing neuroendocrine tumor (NET) of the thymus is a rare cause of Cushing's syndrome (CS). The literature consists mainly of isolated case reports. Patients: We studied 12 cases (eight males and four females) diagnosed between 1986 and 2010 with CS and thymic NET who underwent surgical resection. Main Outcome Measures: We measured time from onset of CS to diagnosis of thymic NET, tumor size, histological grade, time to recurrence, and survival and performed a meta-analysis of other published cases of CS associated with thymic NET. Results: Eleven of 12 patients presented with classic features of CS at a median age of 21 yr (range, 7-51). Four were children. The 24-h urine free cortisol was greater than 16-fold of normal, and biochemical testing was consistent with ectopic ACTH production in all 11. Another patient presenting with pulmonary embolus had a thymic mass and was later diagnosed with CS. All patients underwent thymectomy, and nine of 10 tumors exhibited positive ACTH immunochemistry. Median tumor diameter was 5 cm (frange, 1-11.5). Six patients recurred 20-28 months after surgery with metastases to mediastinal lymph nodes (n = 5), bone (n = 5), liver (n = 1), parotid gland (n = 1), and breast (n = 1). Four of five patients treated with radiation therapy also received chemotherapy. All recurrent patients received ketoconazole; four later underwent bilateral adrenalectomy. Six recurrent patients died 22-90 months (median, 57) after thymectomy. At last review, six patients were alive 14-90 months (median, 49) after thymectomy. These data are similar to those from the meta-analysis. Conclusions: Thymic ACTH-producing NET is an aggressive disease that should be considered in CS with ectopic ACTH secretion, particularly in younger patients.

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