Successful treatment of ectopic Cushing's syndrome with the slow-release somatostatin analog lanreotide:: Case report

A 45-year-old woman presenting with Cushing's syndrome was found to have an ectopic corticotropin (ACTH) secretion. From 1992 to 1995 she was treated with ketoconazole, metyrapone, and combinations of these drugs, with no reduction of cortisol and ACTH levels. A chest CT scan in 1996 revealed a 2 cm nodular image in the thymus. Scintigraphy with In-111-pentetreotide was negative. After thymectomy, histological examination showed a unilocular thymic cyst. Hormonal evaluation after surgery demonstrated persistence of high levels of cortisol and ACTH. A new In-111-pentetreotide scintiscan revealed a small area of uptake at the mediastinum. Therapy with octreotide was started and cortisol and ACTH concentrations fell into the normal range. The therapy was then switched to slow-release lanreotide, 30 mg every 21 days. This was maintained for 12 months. In that year, there was dramatic clinical, improvement and excellent control of hypercortisolism.