A Challenging Case of Cushing’s Syndrome Due to Ectopic Adrenocorticotropic Hormone Secretion
Bibliographic record
Abstract
Adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome secondary to an ectopic source is an uncommon condition. Hypercortisolism due to ectopic ACTH syndrome is usually rapidly progressive, and excess cortisol levels can lead to severe clinical manifestations, potentially life-threatening. We present the case of a 67-year-old woman who presented to the endocrinological evaluation for severe hypokalemia and massive edema of the upper and lower limbs. Hormonal investigations showed elevated plasma total cortisol, 24-h urinary free cortisol, and unsuppressed cortisol following 1 mg and 8 mg dexamethasone suppression test, high level of ACTH suggestive for ACTH-dependent Cushing's syndrome. Calcitonin and chromogranin A levels were also elevated. Head magnetic resonance imaging (MRI) evaluation revealed a pituitary microadenoma. However, in the context of the onset of severe symptoms in the short term and the association of chronic hypokalemia with the failure of plasma cortisol suppression and the very high value of ACTH, a Cushing's syndrome with ectopic secretion of ACTH was suspected. Neck and abdomen computed tomography (CT) scan showed a heterogeneous nodular mass of 14 × 13 mm in size with macrocalcifications in the right thyroid lobe and bilateral adrenal enlargement, confirming the diagnosis of ectopic ACTH syndrome, with thyroid nodule being the likely source of ectopic ACTH secretion. Due to hypokalemia refractory to treatment, severe hypercortisolism in the conditions of unavailability of steroidogenesis inhibitors, emergency bilateral adrenalectomy was performed. Diagnosis of ectopic ACTH syndrome is challenging and requires a multidisciplinary approach. Thyroid evaluation is important to identify a possible source of ectopic secretion of ACTH in the context of medullary thyroid carcinoma (MTC). J Endocrinol Metab. 2023;13(4):164-169 doi: https://doi.org/10.14740/jem889
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.005 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.004 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.008 | 0.006 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".