{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T03:46:02Z","timestamp":1793245562649,"version":"4.5.0"},"reference-count":10,"publisher":"The Endocrine Society","issue":"2","license":[{"start":{"date-parts":[[2023,3,9]],"date-time":"2023-03-09T00:00:00Z","timestamp":1678320000000},"content-version":"vor","delay-in-days":20,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,2,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Delayed diagnosis of Cushing syndrome (CS) results in advanced disease, treatment delays, and poor outcomes. We present a patient with ectopic ACTH syndrome (EAS) from a pancreatic neuroendocrine tumor (NET) whose care posed diagnostic and therapeutic challenges. A 59-year-old female with classic Cushing stigmata, biochemical evidence of ACTH-dependent hypercortisolism, and a 5-mm pituitary lesion presented for inferior petrosal sinus sampling, which was contraindicated due to non-ST elevation myocardial infarction and acute\/subacute strokes. Whole-body computed tomography (CT) scan was unrevealing, but elevations in chromogranin A and proopiomelanocortin (POMC) concentrations suggested EAS. Positron emission tomography-CT with gallium 68-DOTATATE demonstrated a 7-mm pancreatic tail lesion, suspicious for a pancreatic NET. The patient was not a surgical candidate and treatment with ketoconazole was complicated by hepatoxicity. Endoscopic ultrasound-guided biopsy and radiofrequency ablation of the lesion was pursued. Pathology confirmed ACTH immunoreactive low-grade pancreatic NET. Post procedure, sustained normalization of ACTH and cortisol was achieved. This case supports the utility of POMC measurements in the differential diagnosis of CS and the use of advanced nuclear imaging for tumor localization. For patients with functional pancreatic NET who are poor surgical candidates or intolerant of pharmacotherapy, novel endoscopic ablation may offer a low-risk therapeutic option and should be further investigated.<\/jats:p>","DOI":"10.1210\/jcemcr\/luad022","type":"journal-article","created":{"date-parts":[[2023,3,9]],"date-time":"2023-03-09T18:35:23Z","timestamp":1678386923000},"source":"Crossref","is-referenced-by-count":6,"title":["Cushing Syndrome due to a Pancreatic Neuroendocrine Tumor Treated With Radiofrequency Ablation"],"prefix":"10.1210","volume":"1","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0961-1038","authenticated-orcid":false,"given":"Aristea Sideri","family":"Gugger","sequence":"first","affiliation":[{"name":"Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center , New York, NY 10032 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiali","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center , New York, NY 10032 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kavel H","family":"Visrodia","sequence":"additional","affiliation":[{"name":"Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center , New York, NY 10032 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4064-1211","authenticated-orcid":false,"given":"Gabrielle","family":"Page-Wilson","sequence":"additional","affiliation":[{"name":"Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center , New York, NY 10032 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2023,3,9]]},"reference":[{"issue":"3","key":"2024010813064687100_luad022-B1","doi-asserted-by":"crossref","first-page":"e12","DOI":"10.1210\/clinem\/dgz136","article-title":"Time to diagnosis in Cushing\u2019s syndrome: a meta-analysis based on 5367 patients","volume":"105","author":"Rubinstein","year":"2020","journal-title":"J Clin Endocrinol Metab"},{"issue":"12","key":"2024010813064687100_luad022-B2","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1016\/S2213-8587(21)00235-7","article-title":"Consensus on diagnosis and management of Cushing\u2019s disease: a guideline update","volume":"9","author":"Fleseriu","year":"2021","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"10","key":"2024010813064687100_luad022-B3","doi-asserted-by":"crossref","first-page":"E1838","DOI":"10.1210\/jc.2014-1448","article-title":"Clinical utility of plasma POMC and AgRP measurements in the differential diagnosis of ACTH-dependent Cushing's Syndrome","volume":"99","author":"Page-Wilson","year":"2014","journal-title":"J Clin Endocrinol Metab"},{"issue":"1","key":"2024010813064687100_luad022-B4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5114\/aoms.2016.57577","article-title":"Chromogranin A\u2014unspecific neuroendocrine marker. Clinical utility and potential diagnostic pitfalls","volume":"12","author":"Gut","year":"2016","journal-title":"Arch Med Sci"},{"issue":"6","key":"2024010813064687100_luad022-B5","first-page":"1780","article-title":"Effectiveness versus efficacy: the limited value in clinical practice of high dose dexamethasone suppression testing in the differential diagnosis of adrenocorticotropin-dependent Cushing\u2019s Syndrome","volume":"82","author":"Aron","year":"1997","journal-title":"J Clin Endocrinol Metab"},{"issue":"10","key":"2024010813064687100_luad022-B6","doi-asserted-by":"crossref","first-page":"817","DOI":"10.7326\/0003-4819-120-10-199405150-00001","article-title":"Pituitary magnetic resonance imaging in normal human volunteers: occult adenomas in the general population","volume":"120","author":"Hall","year":"1994","journal-title":"Ann Intern Med"},{"issue":"8","key":"2024010813064687100_luad022-B7","doi-asserted-by":"crossref","first-page":"3752","DOI":"10.1210\/jc.2003-032249","article-title":"Diagnostic errors after inferior petrosal sinus sampling","volume":"89","author":"Swearingen","year":"2004","journal-title":"J Clin Endocrinol Metab"},{"issue":"4","key":"2024010813064687100_luad022-B8","doi-asserted-by":"crossref","first-page":"220","DOI":"10.4103\/eus.eus_28_19","article-title":"EUS-guided radiofrequency ablation as an alternative to surgery for pancreatic neuroendocrine neoplasms: who should we treat?","volume":"8","author":"Larghi","year":"2019","journal-title":"Endosc Ultrasound"},{"issue":"5","key":"2024010813064687100_luad022-B9","doi-asserted-by":"crossref","first-page":"E862","DOI":"10.1210\/jc.2013-4359","article-title":"Cushing\u2019s syndrome due to a bronchial ACTH-secreting carcinoid successfully treated with radiofrequency ablation (RFA)","volume":"99","author":"Corsello","year":"2014","journal-title":"J Clin Endocrinol Metab"},{"issue":"S 01","key":"2024010813064687100_luad022-B10","doi-asserted-by":"crossref","first-page":"E1","DOI":"10.1055\/s-0042-118165","article-title":"Cushing\u2019s syndrome managed by endoscopic ultrasound-guided radiofrequency ablation of adrenal gland adenoma","volume":"49","author":"Lee","year":"2017","journal-title":"Endoscopy"}],"container-title":["JCEM Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jcemcr\/article-pdf\/1\/2\/luad022\/51825012\/luad022.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcemcr\/article-pdf\/1\/2\/luad022\/51825012\/luad022.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,8]],"date-time":"2024-01-08T13:35:55Z","timestamp":1704720955000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jcemcr\/article\/doi\/10.1210\/jcemcr\/luad022\/7074442"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,17]]},"references-count":10,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023,2,17]]}},"URL":"https:\/\/doi.org\/10.1210\/jcemcr\/luad022","relation":{},"ISSN":["2755-1520"],"issn-type":[{"value":"2755-1520","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,3,1]]},"published":{"date-parts":[[2023,2,17]]},"article-number":"luad022"}}