Keywords:
Neuroendocrine Neoplasm, Thymic malignancies, Cushing’s disease, Pituitary Incidentaloma, HypercortisolismKey Clinical Message:while evaluating for the cause of Cushing syndrome, biochemical confirmation should be pursued first, one of the rare secondary causes that should be kept in mind is thymic neuroendocrine tum
Abstract: Background:
Thymic neuroendocrine tumors are a very rare group of neoplasms with only a few cases described in the literature. These are considered malignant predisposing them to metastasize. They can present with local symptoms or when functional secrete hormones leading to paraneoplastic syndromes such as acromegaly and Cushing’s syndrome. Cushing’s syndrome is characterized by signs and symptoms due to exposure to excess glucocorticoid. Establishing the diagnosis is difficult as the signs and symptoms may not be obvious.  Amongst several benign and malignant causes, ectopic secretion of ACTH by non-pituitary tumors accounts for about 10 to 15 percent of Cushing’s syndrome. Most ectopic cases are caused by neuroendocrine tumors of the lung, pancreas, or thymus. Due to diagnostic and presentation challenges, it can often be missed. We write this report to highlight a diagnostic dilemma we encountered and the association of thymic neuroendocrine tumors with Cushing’s syndrome.Case report:We report a years old Filipina lady who presented to the hospital with generalized fatigue and weakness. She was found to have Cushing’s syndrome and further evaluation revealed a thymic neuroendocrine tumor that was treated with surgical excision by VATS. The patient had an uncomplicated recovery course with normalization of her blood pressure and hormonal profile.Conclusion:Thymic neuroendocrine malignancies are a rare group of neoplasms that can present with cushing syndrome, it should be kept in mind while dealing with an ectopic cushing syndrome. Mainstay of treatment is surgery, with a good overall survival and outcomes.