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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

doi: 10.1097/RLU.0b013e318262adc7
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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.

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

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

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