{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T13:53:45Z","timestamp":1753883625908,"version":"3.41.2"},"reference-count":6,"publisher":"The Endocrine Society","issue":"3","license":[{"start":{"date-parts":[[2024,3,4]],"date-time":"2024-03-04T00:00:00Z","timestamp":1709510400000},"content-version":"vor","delay-in-days":10,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,2,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Here, we present the case of a 40-year-old man in whom the diagnosis of ectopic adrenocorticotropin (ACTH) syndrome went unrecognized despite evaluation by multiple providers until it was ultimately suspected by a nephrologist evaluating the patient for edema and weight gain. On urgent referral to endocrinology, screening for hypercortisolism was positive by both low-dose overnight dexamethasone suppression testing and 24-hour urinary free cortisol measurement. Plasma ACTH values confirmed ACTH-dependent Cushing syndrome. High-dose dexamethasone suppression testing was suggestive of ectopic ACTH syndrome. Inferior petrosal sinus sampling demonstrated no central-to-peripheral gradient, and 68Ga-DOTATATE scanning revealed an avid 1.2-cm left lung lesion. The suspected source of ectopic ACTH was resected and confirmed by histopathology, resulting in surgical cure. While many patients with Cushing syndrome have a delayed diagnosis, this case highlights the critical need to increase awareness of the signs and symptoms of hypercortisolism and to improve the understanding of appropriate screening tests among nonendocrine providers.<\/jats:p>","DOI":"10.1210\/jcemcr\/luae034","type":"journal-article","created":{"date-parts":[[2024,3,4]],"date-time":"2024-03-04T16:27:47Z","timestamp":1709569667000},"source":"Crossref","is-referenced-by-count":0,"title":["Delayed Diagnosis of Ectopic Cushing Syndrome"],"prefix":"10.1210","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1979-1562","authenticated-orcid":false,"given":"Brooke C","family":"Matson","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Endocrinology and Metabolism, University of North Carolina at Chapel Hill School of Medicine , Chapel Hill, NC 27599-7170 , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua M","family":"Evron","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology and Metabolism, University of North Carolina at Chapel Hill School of Medicine , Chapel Hill, NC 27599-7170 , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven M","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill School of Medicine , Chapel Hill, NC 27599-7525 , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evan M","family":"Zeitler","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill School of Medicine \u00a0 Chapel Hill, NC 27599-7155 , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5894-9054","authenticated-orcid":false,"given":"Klara R","family":"Klein","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology and Metabolism, University of North Carolina at Chapel Hill School of Medicine , Chapel Hill, NC 27599-7170 , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"80","published-online":{"date-parts":[[2024,3,4]]},"reference":[{"issue":"3","key":"2024032207521982000_luae034-B1","doi-asserted-by":"crossref","first-page":"dgz136","DOI":"10.1210\/clinem\/dgz136","article-title":"Time to diagnosis in Cushing's syndrome: a meta-analysis based on 5367 patients","volume":"105","author":"Rubinstein","year":"2020","journal-title":"J Clin Endocrinol Metab"},{"key":"2024032207521982000_luae034-B2","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.jdcr.2021.10.024","article-title":"Disseminated cutaneous Mycobacterium chelonae infection as a presenting sign of ectopic adrenocorticotropic hormone syndrome","volume":"18","author":"Park","year":"2021","journal-title":"JAAD Case Rep"},{"issue":"2","key":"2024032207521982000_luae034-B3","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1001\/jama.2023.11305","article-title":"Cushing syndrome: a review","volume":"330","author":"Reincke","year":"2023","journal-title":"JAMA"},{"issue":"3","key":"2024032207521982000_luae034-B4","doi-asserted-by":"crossref","first-page":"e901","DOI":"10.1210\/clinem\/dgad453","article-title":"Long-term consequences of Cushing's syndrome: a systematic literature review","volume":"109","author":"Puglisi","journal-title":"J Clin Endocrinol Metab"},{"issue":"5","key":"2024032207521982000_luae034-B5","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.1210\/jc.2008-0125","article-title":"The diagnosis of Cushing's syndrome: an Endocrine Society clinical practice guideline","volume":"93","author":"Nieman","year":"2008","journal-title":"J Clin Endocrinol Metab"},{"issue":"721","key":"2024032207521982000_luae034-B6","doi-asserted-by":"crossref","first-page":"399","DOI":"10.3399\/bjgp22X720449","article-title":"Recognising and diagnosing Cushing's syndrome in primary care: challenging but not impossible","volume":"72","author":"Scoffings","year":"2022","journal-title":"Br J Gen Pract"}],"container-title":["JCEM Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jcemcr\/article-pdf\/2\/3\/luae034\/57020874\/luae034.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcemcr\/article-pdf\/2\/3\/luae034\/57020874\/luae034.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,22]],"date-time":"2024-03-22T10:47:13Z","timestamp":1711104433000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jcemcr\/article\/doi\/10.1210\/jcemcr\/luae034\/7618559"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,23]]},"references-count":6,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,2,23]]}},"URL":"https:\/\/doi.org\/10.1210\/jcemcr\/luae034","relation":{},"ISSN":["2755-1520"],"issn-type":[{"type":"electronic","value":"2755-1520"}],"subject":[],"published-other":{"date-parts":[[2024,3]]},"published":{"date-parts":[[2024,2,23]]},"article-number":"luae034"}}