Radiofrequency Ablation: Alternative Treatment of Ectopic Adrenocorticotropic Syndrome Secondary to Lung Carcinoid Tumor.

Ectopic ACTH secretion is a rare, severe condition covering a wide spectrum of tumors of different location and aggressiveness. The usual poor prognosis of patients with ectopic ACTH secretion requires prompt management. We report a case of a patient with high surgical risk and intolerance to cortisol-lowering drug, in which hypercortisolism was successfully treated with radiofrequency ablation of a lung carcinoid tumor. A 78-year-old woman was referred for a rapidly progressive ACTH-dependent Cushing syndrome (CS). Biological tests suggested the presence of CS due to ectopic ACTH production. Imaging studies detected an 11-mm left upper pulmonary lobe nodule. A computed tomography-guided biopsy of the lesion confirmed a well-differentiated ACTH-positive carcinoid tumor with a Ki67 index <10%. The patient started therapy with ketoconazole but developed severe gastrointestinal side effects. Because of a very high surgical risk, lung resection was prohibited. Radiofrequency ablation of the lung carcinoid tumor was performed without major complication. The procedure allowed a progressive control of hypercortisolism with rapid improvement of CS that persists after 1 year. We show that radiofrequency ablation may be an efficient alternative treatment for the management of high surgical risk patients with ectopic ACTH syndrome secondary to a well-differentiated lung carcinoid tumor.