Roberta Modica
University of Naples, Italy
Title: Complete clinical and biochemical control with cabergoline and octreotide in a patient with ectopic ACTH syndrome before surgery
Biography
Biography: Roberta Modica
Abstract
Ectopic ACTH syndrome (EAS) is commonly caused by bronchial carcinoid tumors, whose detection can be challenging. Hypercortisolism requires rapidly effective medical therapy to avoid severe complications. We report a case of a 65-year-old woman with EAS due to an ACTH-secreting typical lung carcinoid, successfully and rapidly managed with cabergoline (CAB) and octreotide (OCT) before surgery. She presented with rapidly worsening Cushing’s syndrome and laboratory findings consistent with EAS. Initially the ACTH source was not localized, thereby acute tests with OCT (100 μg subcutaneous, 150 min) and CAB (1 mg oral, 6 h) were performed. Based on the significant reduction of ACTH and cortisol obtained with both tests, a combined medical treatment with OCT (0.05 mg/8 h) and CAB (0.5 mg three times/week) was started. Only 2 weeks after, biochemical data normalized together with cushingoid features. After the rapid fall of cortisol levels, severe urticaria occurred, thus OCT and CAB were withdrawn. Two weeks later urticaria improved but ACTH and cortisol levels increased again. Therefore CAB only was started again (0.5 mg/week), allowing restoration of normal cortisol levels. One month later, a contrast enhanced chest CT scan revealed a left lung nodule and a low-grade neuroendocrine tumor was removed (15 mm, pT1N0). Low doses of CAB and OCT showed a rapid onset of action with long-lasting effect both on clinical and biochemical parameters without any side effect and without recurrence. In summary, CAB and OCT, in mono- or combined therapy, are a safe and effective approach in EAS before surgery.