Search Results

You are looking at 1 - 3 of 3 items for

  • Author: André Lacroix x
Clear All Modify Search
Stéphanie Larose Division of Endocrinology, Department of Medicine, Centre hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montréal, QC, Canada

Search for other papers by Stéphanie Larose in
Google Scholar
PubMed
Close
,
Dany Rioux Division of Endocrinology, Department of Medicine, Centre hospitalier universitaire régional, Trois-Rivières, QC, Canada

Search for other papers by Dany Rioux in
Google Scholar
PubMed
Close
,
Roula Albadine Department of Pathology, Centre hospitalier de l’Université de Montréal, Université de Montréal (CHUM), Université de Montréal, Montréal, QC, Canada, Montréal, QC, Canada

Search for other papers by Roula Albadine in
Google Scholar
PubMed
Close
, and
André Lacroix Division of Endocrinology, Department of Medicine, Centre hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montréal, QC, Canada

Search for other papers by André Lacroix in
Google Scholar
PubMed
Close

Ectopic adrenocorticotrophic hormone (ACTH) secretion (EAS) is a rare cause of ACTH-dependent Cushing’s syndrome (CS), most often caused by a thoracic neuroendocrine tumor (NET). Large-cell neuroendocrine carcinomas (LCNEC) with EAS are rare and usually present a more severe ACTH secretion and hypercortisolism. We report a 44-year-old non-smoker man, who presented clinical and biochemical evidence of ACTH-dependent CS. Desmopressin 10 μg i.v. produced a 157% increase in ACTH and a 25% increase in cortisol from baseline; there was no stimulation of ACTH or cortisol during the corticotropin-releasing hormone (CRH) test and no suppression with high dose dexamethasone. Pituitary MRI identified a 5 mm lesion, but inferior petrosal venous sinus sampling under desmopressin did not identify a central ACTH source. Thorax and abdominal imaging identified a left lung micronodule. Surgery confirmed a lung LCNEC with strongly positive ACTH immunohistochemistry (IHC) in the primary and lymph node metastasis. The patient was in CS remission after surgery and adjuvant chemotherapy but developed a recurrence 9.5 years later, with LCNEC pulmonary left hilar metastases, ectopic CS, and positive ACTH IHC. This is the first report of LCNEC, with morphologic feature of carcinoid tumor of the lung with ectopic ACTH stimulated by desmopressin. Long delay prior to metastatic recurrence indicates relatively indolent NET. This case report indicates that response to desmopressin, which usually occurs in Cushing’s disease or benign NETs, can occur in malignant LCNEC.

Open access
Nadia Gagnon Division of Endocrinology, Department of Medicine, Centre de Recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada

Search for other papers by Nadia Gagnon in
Google Scholar
PubMed
Close
,
Sophie Bernard Division of Endocrinology, Department of Medicine, Centre de Recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
Lipids, Nutrition and Cardiovascular Prevention Clinic of the Montreal Clinical Research Institute, Montreal, Québec, Canada

Search for other papers by Sophie Bernard in
Google Scholar
PubMed
Close
,
Martine Paquette Lipids, Nutrition and Cardiovascular Prevention Clinic of the Montreal Clinical Research Institute, Montreal, Québec, Canada

Search for other papers by Martine Paquette in
Google Scholar
PubMed
Close
,
Catherine Alguire Division of Endocrinology, Department of Medicine, Centre de Recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada

Search for other papers by Catherine Alguire in
Google Scholar
PubMed
Close
,
André Lacroix Division of Endocrinology, Department of Medicine, Centre de Recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada

Search for other papers by André Lacroix in
Google Scholar
PubMed
Close
,
Pierre-Olivier Hétu Department of Biochemistry, Centre hospitalier de l’Université de Montréal (CHUM), Montreal, Quebec, Canada

Search for other papers by Pierre-Olivier Hétu in
Google Scholar
PubMed
Close
,
Harold J Olney Department of Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada

Search for other papers by Harold J Olney in
Google Scholar
PubMed
Close
, and
Isabelle Bourdeau Division of Endocrinology, Department of Medicine, Centre de Recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada

Search for other papers by Isabelle Bourdeau in
Google Scholar
PubMed
Close

Background

This study examined the magnitude of changes and the time required to observe maximal changes in LDL-c, HDL-c, triglycerides (Tg) and non-HDL-c after the introduction of mitotane.

Methods

Retrospective study of 45 patients with adrenocortical carcinoma who were treated at the Centre hospitalier de l’Université de Montréal. Clinical and biochemical data were collected, including lipid profiles before and during the first year of treatment with mitotane.

Results

Among the 45 studied patients, 26 (58%) had a complete lipid profile before the introduction of mitotane and at least 1 lipid profile during the first year of treatment, and 19 patients (42%) had a lipid profile following initiation of the treatment. Among the 26 patients who had lipid profiles before and after the introduction of mitotane, the increase of LDL-c was 2.19 mmol/L (76%) (P< 0.0001), HDL-c was 0.54 mmol/L (35%) (P= 0.0002), Tg was 1.80 mmol/L (129%) (P< 0.0001) and non-HDL-c was 2.73 mmol/L (79%) (P< 0.0001). Between the first and the sixth month of mitotane treatment, peak values (n  = 45) of LDL-c and non-HDL-c were reached in 42 patients (93%) and 37 patients (82%), respectively, whereas peak values of HDL-c were reached after 6 months of mitotane treatment in 29 patients (66%). The peak value of Tg was almost equal throughout the first year. The mean peak values of HDL-c, Tg and non-HDL-c showed significant associations with their respective mitotane concentrations (β = 0.352, P= 0.03; β = 0.406, P= 0.02 and β = 0.339, P= 0.05).

Conclusion

The introduction of mitotane produces a clinically significant elevation of lipid parameters (LDL-c, HDL-c, Tg and non-HDL-c) during the first year of treatment.

Open access
Nada Younes Division of Endocrinology, and Research Center, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada

Search for other papers by Nada Younes in
Google Scholar
PubMed
Close
,
Isabelle Bourdeau Division of Endocrinology, and Research Center, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada

Search for other papers by Isabelle Bourdeau in
Google Scholar
PubMed
Close
,
Harold Olney Division of Hematology and Medical Oncology, Department of Medicine, and Research Center, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada

Search for other papers by Harold Olney in
Google Scholar
PubMed
Close
,
Paul Perrotte Division of Urology, Department of Surgery, and Research Center, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada

Search for other papers by Paul Perrotte in
Google Scholar
PubMed
Close
,
Odile Prosmanne Department of Radiology, and Research Center, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada

Search for other papers by Odile Prosmanne in
Google Scholar
PubMed
Close
,
Mathieu Latour Department of Pathology, and Research Center, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada

Search for other papers by Mathieu Latour in
Google Scholar
PubMed
Close
,
David Roberge Division of Radiation Oncology, and Research Center, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada

Search for other papers by David Roberge in
Google Scholar
PubMed
Close
, and
André Lacroix Division of Endocrinology, and Research Center, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada

Search for other papers by André Lacroix in
Google Scholar
PubMed
Close

Summary

Needle tract seeding is a potential, albeit rare, complication following transcutaneous biopsies, leading to the seeding of tumor cells along the path of the needle. Biopsies of adrenal masses are not routinely recommended and are only indicated, after exclusion of pheochromocytoma, when an adrenal metastasis of a primary extra-adrenal cancer is suspected or when pathological confirmation of inoperable adrenocortical cancer (ACC) may impact treatment. Despite guideline recommendations to avoid primary adrenal biopsy, very few needle tract seeding cases have been reported and none were in the context of an ACC. We report the occurrence of needle tract seeding in a patient following adrenal transcutaneous biopsy leading to ACC abdominal wall recurrence.

Learning points

  • Needle tract seeding is a rare complication of transcutaneous biopsy. It may increase morbidity and impact overall survival. It has yet to be documented in adrenocortical carcinoma (ACC).

  • Adrenal masses can be accurately evaluated for malignancy using a combination of conventional and metabolic imaging, such as CT and fluorodeoxyglucose-PET, obviating the need for biopsies.

  • Adrenal mass biopsy is not indicated in ACC unless advanced ACC is diagnosed, and a pathological confirmation would impact management.

Open access