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Clinical Nuclear Medicine:
doi: 10.1097/RLU.0b013e318262adc7
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18F-DOPA PET/CT But Not 68Ga-DOTA-TOC PET/CT Revealed the Underlying Cause of Ectopic Cushing Syndrome

Schalin-Jäntti, Camilla PhD, MD*†; Ahonen, Aapo PhD, MD‡§; Seppänen, Marko PhD, MD

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From the *Division of Endocrinology, Institute of Clinical Medicine, University of Helsinki; †Division of Endocrinology, Departments of Medicine and ‡Nuclear Medicine, and §Helsinki PET Centre, Helsinki University Hospital, Helsinki; and ∥Department of Nuclear Medicine and Turku PET Centre, Turku University Hospital, Turku, Finland.

Received for publication November 22, 2011; revision accepted April 23, 2012.

Conflicts of interest and sources of funding: none declared.

Reprints: Camilla Schalin-Jäntti, PhD, MD, Division of Endocrinology, Department of Medicine, Helsinki University Central Hospital, PO Box 340, FI-00290 Helsinki, Finland. E-mail:

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Abstract: 18F-DOPA PET/CT but not 68Ga-DOTA-TOC PET/CT revealed the cause of ectopic Cushing syndrome in a 61-year-old man. The patient presented with rapid weight gain, swollen legs, and sleep disturbances. Plasma potassium level was 2.7 mM (reference range, 3.3–4.9 mM), 24-hour urinary cortisol level was 13,124 nmol (reference range, 30–144 nmol), and plasma adrenocorticotropin level was 61 ng/L (reference range, <48 g/L). CT demonstrated prominent lymph nodes in the left lung hilus and hyperplastic adrenals but no primary tumor. 68Ga-DOTA-TOC PET/CT, which is recommended as the first-line PET imaging, was performed, but it was not diagnostic. Imaging with 18F-DOPA PET/CT revealed the underlying cause.

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The authors thank Tommi Noponen, MedPhys, DSc, for technical help with the figure.

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1. Alexandraki KI, Grossman AB. The ectopic ACTH syndrome. Rev Endocr Metab Disord. 2010; 11: 117–126.

2. Isidori AM, Kaltsas GA, Pozza C, et al.. The ectopic adrenocorticotropin syndrome: clinical features, diagnosis, management, and long-term follow-up. J Clin Endocrinol Metab. 2006; 91: 371–377.

3. Torpy DJ, Mullen N, Ilias I, et al.. Association of hypertension and hypokalemia with Cushing’s syndrome caused by ectopic ACTH secretion. Ann N Y Acad Sci. 2002; 970: 134–144.

4. Ambrosini V, Tomassetti P, Castellucci P, et al.. Comparison between Ga-68-DOTA-NOC and F-18-DOPA PET for the detection of gastro-entero-pancreatic and lung neuro-endocrine tumors. Eur J Nucl Med Mol Imaging. 2008; 35: 1431–1438.

5. Pruthi A, Basu S, Ramani SK, et al.. Bilateral symmetrical adrenal hypermetabolism on FDG PET in paraneoplastic Cushing syndrome in breast cancer: correlation with contrast-enhanced computed tomography. Clin Nucl Med. 2010; 35: 960–961.

6. Terada T. Pulmonary large cell neuroendocrine carcinoma diagnosed in a brain metastasis. Int J Clin Exp Pathol. 2012; 5: 159–162.

7. Eriksson B, Öorlefors H, Öberg K, et al.. Developments in PET for the detection of endocrine tumors. Best Pract Res Clin Endocrinol Metab. 2005; 19: 311–324.

8. Kauhanen S, Seppänen M, Ovaska J, et al.. The clinical value of [18F]fluoro-dihydroxyphenylalanine positron emission tomography in primary diagnosis, staging, and restaging of neuroendocrine tumors. Endocr Relat Cancer. 2009; 16: 255–265.

9. Virgolini I, Ambrosini V, Bomanji JB, et al.. Procedure guidelines for PET/CT tumor imaging with Ga-68-DOTA–conjugated peptides: Ga-68-DOTA-TOC, Ga-68-DOTA-NOC, Ga-68-DOTA-TATE. Eur J Nucl Med Mol Imaging. 2010; 37: 2004–2010.


ectopic Cushing syndrome; LCNEC; NET; neuroendocrine carcinoma; ectopic ACTH; imaging; CT; PET

© 2012 Lippincott Williams & Wilkins, Inc.


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