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Initially, the absence of clinical signs and the demonstration of two normal 24 h urinary free cortisols appeared to exclude the diagnosis, but an ectopic adrenocorticotropin-producing thymic carcinoid was subsequently removed surgically. Cushing's syndrome due to ectopic adrenocorticotropin production can be difficult to diagnose, particularly if there is periodic hormonogenesis.<\/jats:p>","DOI":"10.1136\/pgmj.73.861.426","type":"journal-article","created":{"date-parts":[[2008,12,29]],"date-time":"2008-12-29T21:49:00Z","timestamp":1230587340000},"page":"426-428","source":"Crossref","is-referenced-by-count":11,"title":["Diagnostic difficulties in periodic Cushing's syndrome"],"prefix":"10.1093","volume":"73","author":[{"given":"A B","family":"Walker","sequence":"first","affiliation":[{"name":"Department of Medicine, 5th Floor UCD Building, Royal Liverpool University Hospital , Liverpool, L69 3BX, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G P","family":"Leese","sequence":"additional","affiliation":[{"name":"Department of Medicine, 5th Floor UCD Building, Royal Liverpool University Hospital , Liverpool, L69 3BX, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J P","family":"Vora","sequence":"additional","affiliation":[{"name":"Department of Medicine, 5th Floor UCD Building, Royal Liverpool University Hospital , Liverpool, L69 3BX, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[1997,7,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1016\/S0140-6736(00)84800-X","article-title":"A case of pluriglandular syndrome (diabetes of bearded woman)","volume":"ii:","author":"Brown, W.H.","year":"1928","unstructured":"Brown WH. 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J Clin Endocrinol Metab 1971; 32: 317 - 27.","journal-title":"J Clin Endocrinol Metab"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1210\/jcem-43-4-913","article-title":"Periodic remission in Cushing's disease with paradoxical periodic hormonogenesis","volume":"43","author":"Liberman, B.; Wajchenberg, B.L.; Tambascia, M.C.; Mesquita, C.H.","year":"1976","unstructured":"Liberman B, Wajchenberg BL, Tambascia MC, Mesquita CH. Periodic remission in Cushing's disease with paradoxical periodic hormonogenesis. J Clin Endocrinol Metab 1976; 43: 913-8.","journal-title":"J Clin Endocrinol Metab"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1111\/j.1365-2265.1992.tb01447.x","article-title":"Cyclical Cushing's syndrome first diagnosed after pituitary surgery: a trap for the unwary","volume":"36","author":"Atkinson, A.B.; McCance, D.R.; Kennedy, L.; Sheridan, B.","year":"1992","unstructured":"Atkinson AB, McCance DR, Kennedy L, Sheridan B. Cyclical Cushing's syndrome first diagnosed after pituitary surgery: a trap for the unwary. Clin Endocrinol 1992; 36: 297-300.","journal-title":"Clin Endocrinol"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1530\/acta.0.0990364","article-title":"A case of ectopic ACTH syndrome: diagnostic difficulties caused by intermittent hormone secretion","volume":"99","author":"Thorner, M.O.; Martin, W.H.; Ragan, G.E.","year":"1982","unstructured":"Thorner MO, Martin WH, Ragan GE, et al. A case of ectopic ACTH syndrome: diagnostic difficulties caused by intermittent hormone secretion. 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