Although Cushing syndrome (CS) is commonly associated with pituitary or adrenal gland disease, it can also occur as a paraneoplastic manifestation of medullary thyroid carcinoma (MTC), according to a recently published case report in Clinical Medicine.
The study involved a 63-year-old man with a history of hypertension and diabetes, hospitalized due to a parotid abscess. During the examination, physical signs of CS were evident, including central obesity, moon face, malar erythema, widespread bruising, dorsal hump, cutaneous atrophy, and proximal muscle weakness. Cortisol level studies revealed elevated cortisol levels as well as increased ACTH secretion.
“The secretion of ectopic ACTH secondary to MTC can present with clinical features similar to classical Cushing syndrome, but cases of ectopic CS may exhibit more pronounced symptoms,” the authors wrote.
Further imaging tests, including abdominal and cerebral computed tomography (CT) scans, discarded adrenal and pituitary gland abnormalities. However, a cervical-thoracic CT scan revealed a 3 cm nodule in the right thyroid lobe with coarse calcifications.
Read more about MTC complications
Subsequent sonographic examination revealed an enlarged thyroid due to a nodule with vascularization and calcifications, which was classified as TIRADS 4. The findings led to a nodule biopsy that confirmed the MTC diagnosis.
The patient underwent a total thyroidectomy with lymph node dissection as the primary therapeutic approach for MTC. Seven days after surgery, the patient died due to a heart attack, likely due to the increased cardiovascular risk associated with CS.
The case emphasizes the need for comprehensive evaluation and monitoring in patients with unusual presentations of CS to guarantee appropriate clinical management and prevent complications.
“In conclusion, this exceptional case highlights an unusual presentation of Cushing syndrome with an ectopic origin linked to medullary thyroid carcinoma. It underscores the importance of identifying the syndrome’s etiology and ruling out a paraneoplastic origin,” the authors concluded.
Ruiz-Manzanera JJ, Febrero B, Rodríguez JM. Síndrome de Cushing como presentación de un carcinoma medular de tiroides. Med Clín. Published online July 18, 2023. doi:10.1016/j.medcli.2023.06.013