期刊
ENDOCRINOLOGY AND METABOLISM CLINICS OF NORTH AMERICA
卷 47, 期 2, 页码 409-+出版社
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.ecl.2018.01.005
关键词
Ectopic; Cushing's; ACTH; Carcinoid; Neuroendocrine tumor; Small cell lung cancer
Despite modern imaging techniques, differentiating ectopic adrenocorticotropic hormone (ACTH) syndrome from pituitary-dependent Cushing's syndrome, Cushing's disease, is especially difficult when well-differentiated carcinoids are the source of ACTH secretion, particularly pulmonary carcinoid tumors. ACTH-secreting pulmonary carcinoids, such as the corticotroph adenomas causing Cushing's disease, are often small and difficult to detect, and patients present with a gradual onset of the classical signs and symptoms of Cushing's syndrome, indistinguishable from the presentation of Cushing's disease. Hence, the differential diagnosis relies on a combination of clinical assessment, dynamic biochemical tests, inferior petrosal sinus sampling, and multimodal imaging, each with its own caveats and pitfalls.
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