03 April 2025
: Case report 
A Rare Case of Metastatic Adrenocorticotrophic Hormone – Secreting Pancreatic Neuroendocrine Tumor Causing Ectopic Cushing Syndrome in a 46-Year-Old Woman
Challenging differential diagnosis, Rare disease
Jessica Y. Huang1ABCDEF, Nikitha A. Cherayil
2CDEF, Paul Boyd 1ACE, Maher Ali3BCD, Shazia Samanani1ABCDEF*
DOI: 10.12659/AJCR.945653
Am J Case Rep 2025; 26:e945653
Table 1. Summary of the patient’s notable biochemical markers in relation to her day of admission and relevant treatments.
| Hospital day | Cortisol level (µg/dL) | ACTH Llevel (mg/mL) | Therapeutic changes |
|---|---|---|---|
| 0 | 42.1 | 254 | |
| 6 | 63.9 | ||
| 7 | 80.3 | ||
| 10 | Ketoconazole started, 200 mg twice daily | ||
| 11 | 48.2 | ||
| 13 | Ketoconazole increased to 600 mg every 6 hours | ||
| 14 | 39.6 | 140 | |
| 15 | 15.7 | ||
| 17 | 28.6 | Octreotide started, 50 µg every 6 hours | |
| 18 | 19.3 | ||
| 19 (pre-op) | 18 | 150 | Steroid replacement started, operative (Whipple) day |
| 20 (post-op) | 6.38 | 19.8 | Ketoconazole and octreotide stopped |
| 22 | 2.42 | 23 | |
| 25 | 7.28 | 14.5 |