CASE REPORT: Ectopic ACTH syndrome complicated by multiple opportunistic infections treated with percutaneous ablation of the adrenal glands

Chan, Chrystal
Roberts, James Mark

¹Department of Medicine, University of British Columbia, Vancouver, Canada,

Correspondence to Dr Chrystal Chan, e-mail; [email protected]

/Accepted November 3, 2017

Contributors CC was the primary author in this manuscript. She is a resident who was involved in the patient's care. She consented the patient for case report publication, wrote up the case, and performed a literature review and analysis. JMR is an internal medicine attending who was involved in the patient's care. He provided guidance in writing the report and was involved in the editing process.

Competing interests None declared.

Patient consent Obtained.

Provenance and peer review Not commissioned; externally peer reviewed.

BMJ Case Reports 2017:p 221580, January 2017. | DOI: 10.1136/bcr-2017-221580

Ectopic adrenocorticotropic hormone (ACTH)-related Cushing's syndrome can lead to multiple complications including severe immunosuppression. If the ACTH-secreting tumour cannot be found, definitive treatment is surgical adrenalectomy, typically followed by glucocorticoid replacement. Here, we present a case of fulminant respiratory failure secondary to coinfection with Pneumocystis jirovecii and cytomegalovirus in a patient with ectopic ACTH-dependent Cushing's syndrome with occult primary. Due to significant deconditioning, she was unable to undergo definitive adrenalectomy and instead underwent percutaneous microwave ablation of the adrenal glands.