肺部肿瘤致异位ACTH综合征7例报告并文献复习

摘要

Objective To analyze the clinical features of patients with ectopic ACTH syndrome caused by pulmonary neoplasm. Method Seven cases of ectopic ACTH syndrome caused by pulmonary neoplasm who were diagnosed in the General Hospital of the People' s Liberation Army from 2000 to 2009 were analyzed retrospectively. Results Most patients admitted hospital because of hypertension, hyperglycemia, hypokalemia and edema, without overt presentation of Cushing syndrome. Laboratory findings included remarkable elevated plasma ACTH, plasma cortisol and 24-h UFC. Cortisol secretion could not be suppressed by neither low dose nor high dose dexamethasone suppression test. Lung lesions could mostly be detected by thin-section chest CT scan. Resection of the primary lung lesions and chemotherapy of small cell lung cancer were the optimal treatments. Bilateral adrenalectomy could help to relieve the symptoms caused by hypercortisolism. Conclusions Pulmonary neoplasm is the common source of ectopic ACTH syndrome. ACTH-dependent Cushing syndrome should be routinely screened by thin-section chest CT scan.%目的 探讨肺部肿瘤致异位促肾上腺皮质激素(ACTH)综合征的临床特点.方法 回顾性分析2000年11月～2009年12月解放军总医院内分泌科收治并确诊的7例肺部肿瘤致异位ACTH综合征患者的临床资料.结果 高血压、糖尿病、低血钾、水肿为最常见的临床表现,多缺乏典型库欣综合征的体征;血ACTH和皮质醇、24 h尿游离皮质醇水平升高,皮质醇分泌均不被小剂量及大剂量地塞米松抑制试验所抑制;胸部薄层CT扫描能发现多数肺部病变;手术切除肺部病变、小细胞肺癌化疗效果较好;肾上腺切除为控制高皮质醇血症的有效手段.结论 肺部肿瘤是导致异位ACTH综合征的常见病因,对于ACTH依赖性库欣综合征的患者应常规行胸部薄层CT来筛查肺部病变.