Sutton Brian J, Parks Graham E, Manavi Cyrus K, Palavecino Elizabeth L, Geisinger Kim R
Department of Pathology, Wake Forest University School of Medicine, Winston Salem, NC, USA.
Diagn Cytopathol. 2011 May;39(5):359-62. doi: 10.1002/dc.21428. Epub 2010 Sep 20.
Ectopic hormone production is an uncommon complication of neoplastic lung disease. Rarely, patients may present with signs and symptoms of systemic endocrine dysfunction related to a hormone-secreting tumor. Bronchopulmonary carcinoids are the most common neoplasm implicated in ectopic ACTH-dependent Cushing's syndrome. Persistent hypercortisolism, such as that which occurs in Cushing's syndrome, causes immunosuppression and makes patients vulnerable to opportunistic infections. We present a case of a 42-year-old woman diagnosed with ACTH-dependent Cushing's syndrome which was originally thought to stem from a pituitary lesion as interpreted on magnetic resonance imaging. Her symptoms persisted after undergoing hypophysectomy, and further work-up involving a fine needle aspiration of the left lung revealed an ACTH-producing carcinoid tumor. Before treatment could be administered, the patient developed several new suspicious nodules in the left lung that were shown by fine needle aspiration to be infectious in nature. A Gram stain revealed numerous Gram positive branching organisms, and culture of the specimen grew Nocardia asteroides. Her pulmonary infection was treated with antibiotics and she underwent successful ablation of the carcinoid tumor.
异位激素产生是肺部肿瘤疾病的一种罕见并发症。很少有患者会出现与分泌激素的肿瘤相关的全身性内分泌功能障碍的体征和症状。支气管肺类癌是导致异位促肾上腺皮质激素（ACTH）依赖性库欣综合征的最常见肿瘤。持续的皮质醇增多症，如库欣综合征中出现的情况，会导致免疫抑制，使患者易患机会性感染。我们报告一例42岁女性，诊断为ACTH依赖性库欣综合征，最初磁共振成像显示该综合征被认为源于垂体病变。垂体切除术后她的症状仍持续存在，进一步检查包括对左肺进行细针穿刺活检，结果显示为产生ACTH的类癌肿瘤。在开始治疗之前，患者左肺出现了几个新的可疑结节，细针穿刺活检显示这些结节本质上是感染性的。革兰氏染色显示有许多革兰氏阳性分支杆菌，标本培养长出了星形诺卡菌。她的肺部感染用抗生素进行了治疗，并且成功地切除了类癌肿瘤。
