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A patient with Cushing syndrome and reduced lung volumes.

Article Excerpt
We present a rare case of Cushing syndrome resulting from thymic carcinoid of the lung. Although Cushing syndrome is not usually associated with respiratory muscle weakness or restriction, our patient had reduced lung volumes and expiratory muscle weakness. His reduced lung volumes could not be completely explained by respiratory muscle weakness, parenchymal lung disease, or obesity. Six months after removal of the carcinoid tumor, the patient's growth hormone level and the lung volumes improved significantly, and he became asymptomatic.

The case

A 27-year-old nonsmoker was admitted to the hospital complaining of low back pain, weight gain, and proximal muscles weakness for several months. He had cushingoid appearance and proximal muscle weakness in all extremities, especially the quadriceps. A high random urinary free cortisol level led to the diagnosis of Cushing syndrome.

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Further workup showed a high serum cortisol level (40 [micro]g/dL [normal, 5 to 25 [micro]g/dL]) and nonsuppressible elevation of adrenocorticotropic hormone (ACTH) in the serum (143 pg/mL [normal, 7 to 69 pg/mL]). The insulinlike growth factor I (IGF-I) level, however, was significantly reduced (62 ng/mL [normal, 117 to 329 ng/mL]). No tumor was identified on sella imaging, and findings from bilateral venous sampling of the inferior petrosal sinuses were nondiagnostic.

Findings on a CT scan of the chest and abdomen were normal except for compression deformities of the vertebral bodies of the thoracic and lumbar spine. Therefore, ectopic ACTH production was suspected. An octreotide scan revealed 2 areas of abnormality in the chest, consistent with somatastatin receptor -positive neoplasm (Figure 1). No endobronchial lesion was noted on bronchoscopy.

Preoperative pulmonary function tests revealed...

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