(18)Flurodeoxyglucose positron emission tomography in the localization of ectopic ACTH-secreting neuroendocrine tumours

Objective Neuroendocrine tumours (NET) are a rare cause of Cushing's syndrome. These tumours can be very small and therefore difficult to identify. Current localization techniques include CT, MRI and radioisotope scanning, but in a proportion of cases the NET remains occult. Positron emission tomography (PET) scanning, is a relatively new imaging modality that is increasingly used to detect and monitor lesions with high metabolic activity. We report on the use of PET scanning in the evaluation of the ectopic ACTH syndrome. Patients Three patients with ectopic ACTH-dependent Cushing's syndrome with varying difficulty in NET localization are included in the report. Measurement Positron emission tomography scanning using (18)flurodeoxyglucose (FDG) identifies tissue with high metabolic activity. (18)FDG-PET scanning was used in each of these patients and the imaging is presented along with biochemical data. Results In each case the NET was easily identified using (18)FDG-PET, aiding clinical decision making and therapeutic outcome. A cure was identified by clinical resolution of symptoms and undetectable ACTH levels postsurgery. Conclusions (18)FDG-PET assisted in localizing small metabolically active NETs, suggesting this imaging modality may have a useful role in identifying NET causing Cushing's syndrome as a result of ectopic ACTH production