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August 25, 1978

Misleading Corticotropin Levels in Cushing's Disease

Author Affiliations

From the Departments of Medicine and Endocrinology (Dr Newton), General and Respiratory Medicine (Dr Semple), Biochemical Medicine (Dr Browning), and Surgery (Dr Gunn), Ninewells Hospital and Medical School, Dundee, Scotland.

JAMA. 1978;240(8):770-771. doi:10.1001/jama.1978.03290080060030

PATIENTS with ectopic adrenocorticotropic hormone (ACTH) production frequently do not show all the typical clinical features of Cushing's syndrome despite high plasma ACTH and cortisol levels.1 Classically, severe hypokalemic alkalosis and hyperglycemia occur. Occasionally a cushingoid appearance may develop in association with low-grade malignant and benign tumors such as carcinoid tumors of the lung.2

In our patient ectopic ACTH production was suspected despite a grossly cushingoid appearance because of exceedingly high plasma ACTH and cortisol levels. The subsequent clinical course, however, led to the diagnosis of Cushing's disease because of excess pituitary ACTH secretion exhibiting periodicity of hormone production. We report the case because of the unusual presentation and the misleading levels of plasma ACTH and cortisol.

Report of a Case  A 55-year-old woman who smoked but had no past history of chest disease was admitted to hospital with pneumonia. Consolidation of the right upper lobe was confirmed