{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:45Z","timestamp":1784557065083,"version":"3.55.0"},"reference-count":0,"publisher":"Bioscientifica","license":[{"start":{"date-parts":[[2019,7,26]],"date-time":"2019-07-26T00:00:00Z","timestamp":1564099200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2019,7,26]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>Ectopic ACTH-secreting pulmonary neuroendocrine tumors are rare and account for less than 5% of endogenous Cushing\u2019s syndrome cases. We describe an unusual case of metastatic bronchial carcinoid tumor in a young woman presenting with unprovoked pulmonary emboli, which initially prevented the detection of the primary tumor on imaging. The source of ectopic ACTH was ultimately localized by a Gallium-DOTATATE scan, which demonstrated increased tracer uptake in a right middle lobe lung nodule and multiple liver nodules. The histological diagnosis was established based on a core biopsy of a hepatic lesion and the patient was started on a glucocorticoid receptor antagonist and a somatostatin analog. This case illustrates that hypercogulability can further aggravate the diagnostic challenges in ectopic ACTH syndrome. We discuss the literature on the current diagnosis and management strategies for ectopic ACTH syndrome.<\/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>In a young patient with concurrent hypokalemia and uncontrolled hypertension on multiple antihypertensive agents, secondary causes of hypertension should be evaluated.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Patients with Cushing\u2019s syndrome can develop an acquired hypercoagulable state leading to spontaneous and postoperative venous thromboembolism.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Pulmonary emboli may complicate the imaging of the bronchial carcinoid tumor in ectopic ACTH syndrome.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Imaging with Gallium-68 DOTATATE PET\/CT scan has the highest sensitivity and specificity in detecting ectopic ACTH-secreting tumors.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>A combination of various noninvasive biochemical tests can enhance the diagnostic accuracy in differentiating Cushing\u2019s disease from ectopic ACTH syndrome provided they have concordant results. Bilateral inferior petrosal sinus sampling remains the gold standard.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>","DOI":"10.1530\/edm-19-0033","type":"journal-article","created":{"date-parts":[[2019,7,26]],"date-time":"2019-07-26T10:22:59Z","timestamp":1564136579000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":0,"title":["Pulmonary embolism as the presenting symptom and a confounder in ACTH-secreting bronchial carcinoid"],"prefix":"10.1530","volume":"2019","author":[{"given":"Wei","family":"Yang","sequence":"first","affiliation":[{"name":"1Division of Endocrinology, Department of Internal Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Pham","sequence":"additional","affiliation":[{"name":"2Department of Radiology, University of California Davis School of Medicine, Sacramento, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aren T","family":"Vierra","sequence":"additional","affiliation":[{"name":"1Division of Endocrinology, Department of Internal Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Azam","sequence":"additional","affiliation":[{"name":"1Division of Endocrinology, Department of Internal Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorina","family":"Gui","sequence":"additional","affiliation":[{"name":"3Department of Pathology, University of California Davis School of Medicine, Sacramento, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C","family":"Yoon","sequence":"additional","affiliation":[{"name":"1Division of Endocrinology, Department of Internal Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","container-title":["Endocrinology, Diabetes &amp; Metabolism Case Reports"],"original-title":[],"link":[{"URL":"https:\/\/edm.bioscientifica.com\/view\/journals\/edm\/2019\/1\/EDM19-0033.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/edm.bioscientifica.com\/downloadpdf\/journals\/edm\/2019\/1\/EDM19-0033.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T13:47:05Z","timestamp":1784555225000},"score":1,"resource":{"primary":{"URL":"http:\/\/journals.bioscientifica.com\/edm\/article\/35378"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7,26]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1530\/edm-19-0033","relation":{},"ISSN":["2052-0573"],"issn-type":[{"value":"2052-0573","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,7,26]]}}}