The Mount Sinai Clinical Pathway for the Diagnosis and Management of Hypercortisolism due to Ectopic ACTH Syndrome

Eva L. Alba, Emily A. Japp, Gustavo Fernandez-Ranvier, Ketan Badani, Eric Wilck, Munir Ghesani, Andrea Wolf, Edward M. Wolin, Virginia Corbett, David Steinmetz, Maria Skamagas, Alice C. Levine

Research output: Contribution to journalArticlepeer-review

Abstract

Neoplasms that secrete ectopic adrenocorticotropin (ACTH) may cause severe, life-threatening hypercortisolism. These tumors are often difficult to localize and treat, requiring a comprehensive and systematic management plan orchestrated by a multidisciplinary team. The Mount Sinai Adrenal Center hosted an interdisciplinary retreat of experts in adrenal disorders and neuroendocrine tumors (NETs) with the aim of developing a clinical pathway for the management of Cushing syndrome due to ectopic ACTH production. The result was institutional recommendations for the diagnosis, localization, surgical approaches to intrathoracic tumors and bilateral adrenalectomy, and perioperative and postoperative medical management of hypercortisolism and its sequelae. Specific recommendations were made regarding the timing and selection of therapies based on the considerations of our team as well as a review of the current literature. Our clinical pathway can be applied by other institutions directly or serve as a guide for institution-specific management.

Original languageEnglish
Article numberbvac073
JournalJournal of the Endocrine Society
Volume6
Issue number7
DOIs
StatePublished - 1 Jul 2022

Keywords

  • Cushing syndrome
  • ectopic ACTH
  • hypercortisolism

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