Keywords:
Neuroendocrine Neoplasm, Thymic malignancies, Cushing’s disease,
Pituitary Incidentaloma, HypercortisolismKey
Clinical Message:while evaluating for the cause of Cushing syndrome, biochemical
confirmation should be pursued first, one of the rare secondary causes
that should be kept in mind is thymic neuroendocrine tum
Abstract:
Background:
Thymic neuroendocrine tumors are a
very rare group of neoplasms with only a few cases described in the
literature. These are considered malignant predisposing them to
metastasize. They can present with local symptoms or when functional
secrete hormones leading to paraneoplastic syndromes such as acromegaly
and Cushing’s syndrome. Cushing’s syndrome is characterized by signs and
symptoms due to exposure to excess glucocorticoid. Establishing the
diagnosis is difficult as the signs and symptoms may not be obvious.
Amongst several benign and malignant causes, ectopic secretion of ACTH
by non-pituitary tumors accounts for about 10 to 15 percent of Cushing’s
syndrome. Most ectopic cases are caused by neuroendocrine tumors of the
lung, pancreas, or thymus. Due to diagnostic and presentation
challenges, it can often be missed. We write this report to highlight a
diagnostic dilemma we encountered and the association of thymic
neuroendocrine tumors with Cushing’s syndrome.Case report:We report a years old Filipina lady who presented to the hospital with
generalized fatigue and weakness. She was found to have Cushing’s
syndrome and further evaluation revealed a thymic neuroendocrine tumor
that was treated with surgical excision by VATS. The patient had an
uncomplicated recovery course with normalization of her blood pressure
and hormonal profile.Conclusion:Thymic neuroendocrine malignancies are a rare group of neoplasms that
can present with cushing syndrome, it should be kept in mind while
dealing with an ectopic cushing syndrome. Mainstay of treatment is
surgery, with a good overall survival and outcomes.