{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:16:58Z","timestamp":1784557018428,"version":"3.55.0"},"reference-count":28,"publisher":"Bioscientifica","license":[{"start":{"date-parts":[[2018,3,8]],"date-time":"2018-03-08T00:00:00Z","timestamp":1520467200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/3.0\/deed.en_GB"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,3,8]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>The objective of this study is to report three cases of paraneoplastic or ectopic Cushing syndrome, which is a rare phenomenon of the adrenocorticotropic hormone (ACTH)-dependent Cushing syndrome. Three cases are reported in respect of clinical presentation, diagnosis and treatment in addition to relevant literature review. The results showed that ectopic ACTH secretion can be associated with different types of neoplasm most common of which are bronchial carcinoid tumors, which are slow-growing, well-differentiated neoplasms with a favorable prognosis and small-cell lung cancer, which are poorly differentiated tumors with a poor outcome. The latter is present in two out of three cases and in the remaining one, primary tumor could not be localized, representing a small fraction of patients with paraneoplastic Cushing. Diagnosis is established in the setting of high clinical suspicion by documenting an elevated cortisol level, ACTH and doing dexamethasone suppression test. Treatment options include management of the primary tumor by surgery and chemotherapy and treating Cushing syndrome. Prognosis is poor in SCLC. We concluded that in front of a high clinical suspicion, ectopic Cushing syndrome diagnosis should be considered, and identification of the primary tumor is essential.<\/jats:p>\n                  <jats:sec>\n                    <jats:title>Learning points:<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>Learning how to suspect ectopic Cushing syndrome and confirm it among all the causes of excess cortisol.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Distinguish between occult and severe ectopic Cushing syndrome and etiology.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Providing the adequate treatment of the primary tumor as well as for the cortisol excess.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Prognosis depends on the differentiation and type of the primary malignancy.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>","DOI":"10.1530\/edm-18-0004","type":"journal-article","created":{"date-parts":[[2018,3,8]],"date-time":"2018-03-08T06:00:26Z","timestamp":1520488826000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":11,"title":["Case-series of paraneoplastic Cushing syndrome in small-cell lung cancer"],"prefix":"10.1530","volume":"2018","author":[{"given":"Carine Ghassan","family":"Richa","sequence":"first","affiliation":[{"name":"1Department of Endocrinology, Mount Lebanon Hospital, Beirut, Lebanon"},{"name":"2Lebanese University, Hadath, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khadija Jamal","family":"Saad","sequence":"additional","affiliation":[{"name":"1Department of Endocrinology, Mount Lebanon Hospital, Beirut, Lebanon"},{"name":"2Lebanese University, Hadath, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georges Habib","family":"Halabi","sequence":"additional","affiliation":[{"name":"1Department of Endocrinology, Mount Lebanon Hospital, Beirut, Lebanon"},{"name":"3Mount Lebanon Hospital, Beirut, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elie Mekhael","family":"Gharios","sequence":"additional","affiliation":[{"name":"1Department of Endocrinology, Mount Lebanon Hospital, Beirut, Lebanon"},{"name":"3Mount Lebanon Hospital, Beirut, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fadi Louis","family":"Nasr","sequence":"additional","affiliation":[{"name":"3Mount Lebanon Hospital, Beirut, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie Tanios","family":"Merheb","sequence":"additional","affiliation":[{"name":"1Department of Endocrinology, Mount Lebanon Hospital, Beirut, Lebanon"},{"name":"3Mount Lebanon Hospital, Beirut, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"ref171","first-page":"621","article-title":"Cushing\u2019s paraneoplastic syndrome as first manifestation of an adenocarcinoma of unknown origin","volume":"8","year":"2016","journal-title":"Clinical and Translational Oncology"},{"key":"ref101","first-page":"4","article-title":"Case report Cushing\u2019s syndrome due to ectopic ACTH from bronchial carcinoid: a case report and review","year":"2012","journal-title":"Case Reports in Endocrinology"},{"key":"ref131","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1016\/j.revmed.2014.12.008","article-title":"Le syndrome de Cushing paran\u00e9oplasique, un vrai d\u00e9fi diagnostique et th\u00e9rapeutique: \u00e0 propos d\u2019un cas et revue de la 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in disguise: a progressive olfactory neuroblastoma complicated with ectopic Cushing syndrome","volume":"3","year":"2017","journal-title":"AACE Clinical Case Reports"},{"key":"ref71","first-page":"140","article-title":"The ectopic adrenocorticotropic hormone syndrome in carcinoid tumors","volume":"21","year":"2008","journal-title":"Proceedings"},{"key":"ref261","first-page":"1","article-title":"Case report a challenging case of an ectopic Cushing syndrome","year":"2014","journal-title":"Case Reports in Medicine"},{"key":"ref161","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1097\/JTO.0000000000000116","article-title":"Prognostic impact of paraneoplastic Cushing\u2019s syndrome in small-cell lung cancer","volume":"9","year":"2014","journal-title":"Journal of Thoracic Oncology"},{"key":"ref61","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1111\/1759-7714.12403","article-title":"Ectopic Cushing syndrome in small cell lung cancer: a case report and literature 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