Objective To investigate the clinical idea for diagnosis of ectopic adrenocorticotropic hormone (ACTH) syndrome. Methods The clinical features of two cases of ectopic ACTH syndrome were analyzed and the related literatures were reviewed. Rsults The patients experienced the level of ACTH and urinary-free cortisol significantly increased and there were no changes on high-dose and low-dose dexamethasone suppression test. One patient' s chest computed tomography (CT) examination indicated a nodule in the lower lobe of left lung which was carcinoid tumor confirmed by surgery. Another patient' s chest CT indicated some small nodules in the upper lobe and middle lobe of right lung, but the nature was not clear. Octreotide imaging was negative, so PET / CT examination was carried out . There was radioactive concentration in the upper lobe of right lung in PET/CT, which indicated the nodule may be neuroendocrine tumor. Conclusion The ectopic ACTH syndrome have various clinical manifestations, When current routine techniques combined with octreotide scanning can not clearly identify the nature and location of the ectopic ACTH syndrome. PET / CT can greatly improve the tumor detection rate, which is important for the further treatment.%目的 探讨异位促肾上腺皮质激素(ACTH)综合征的临床诊断策略.方法 分析2例异位ACTH综合征患者临床特点并做文献复习.结果 2例患者均存在血ACTH和尿游离皮质醇水平明显升高,大小剂量地塞米松抑制试验不能抑制等临床特点.1例患者胸部CT检查发现左下肺结节,经手术证实为类癌.另1例患者胸部CT检查发现右上肺、中肺多个小结节样影,不能明确性质；奥曲肽显像结果阴性；18F-脱氧葡萄糖正电子发射断层显像/CT(PET/CT)检查于右肺上叶前段见一放射性浓聚结节影,提示神经内分泌肿瘤.结论 异位ACTH综合征患者临床表现各异,当常规影像学检查结合奥曲肽显像不能明确肿瘤性质和部位时,PET/CT检查可提高肿瘤的检出率,有利于患者的进一步治疗.
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