A case of pulmonary carcinoid tumor with a superimposed aspergilloma presenting as a covert ectopic adrenocorticotropic hormone syndrome

Kyoung Jin Kim, Ji Hee Yu, Nan Hee Kim, Young Hye Kim, Young Sik Kim, Ji A Seo

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4 Citations (Scopus)


Ectopic adrenocorticotropic hormone (ACTH) syndrome is a challenging diagnosis only responsible for approximately 10% of Cushing syndrome cases. It has been associated with a variety of benign and malignant tumors including a carcinoid tumor accompanied by aspergilloma in our case that was significantly difficult to be detected. We report a patient over 70 years old with uncontrolled hypertension and hypokalemia presenting with generalized edema. Laboratory results revealed ACTH-dependent Cushing syndrome, but imaging studies did not show any discrete lesions secreting ACTH. The petrosal to peripheral ACTH gradient resulted in no evidence of pituitary adenoma. As the only lesion suspicious for ectopic ACTH secretion was a right lower round cystic lesion that did not appear to be a carcinoid tumor on computed tomography scan of the chest, the patient underwent video-assisted thoracic surgical resection to provide a definitive diagnosis. The final diagnosis was a small ectopic ACTH-secreting carcinoid tumor with unusual superimposed aspergilloma in the periphery of the lung. Postoperatively, the abnormal endocrine levels were normalized, and all of the clinical symptoms and signs were ameliorated. This is an informative case of ectopic ACTH syndrome (EAS) that was the cause of hypokalemia, hypertension, metabolic alkalosis, and hypercortisolism despite its poorly specific cushingoid morphology and uncommon imaging findings. Therefore, we recommend that clinicians investigate any possible lesion as a potential source of EAS.

Original languageEnglish
Article number123
JournalFrontiers in Endocrinology
Issue numberJUN
Publication statusPublished - 2017 Jun 8

Bibliographical note

Funding Information:
The authors would like to thank radiologist Dr. Ki Yeol Lee for her help. This study was supported by a grant (NRF-2015R1A2A2A01003167) from the National Research Foundation.

Publisher Copyright:
© 2017 Kim, Yu, Kim, Kim, Kim and Seo.


  • Aspergilloma
  • Cushing syndrome
  • Ectopic adrenocorticotropic hormone syndrome
  • Hypercortisolism
  • Pulmonary carcinoid tumor

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism


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