Intraoperative measurement of adrenocorticotropin (ACTH) during removal of ACTH-secreting bronchial carcinoid tumors. J Clin Endocrinol Metab 1995 Mar;80(3):1036-9
Date
03/01/1995Pubmed ID
7883819DOI
10.1210/jcem.80.3.7883819Scopus ID
2-s2.0-0028919092 (requires institutional sign-in at Scopus site) 21 CitationsAbstract
The optimal treatment for ectopic ACTH syndrome is the complete removal of the tumor secreting ACTH. These tumors are often occult, with their location suggested but not proven with imaging techniques. The intraoperative measurement of ACTH by immunoradiometric assay in five patients with the occult ectopic ACTH syndrome during removal of suspicious intrapulmonary lesions is reported. A significant ACTH gradient was detected in the pulmonary veins of the affected lobes in two patients. ACTH had decreased significantly in all five patients by 10 and 15 min after tumor removal. All five patients had histologically proven ACTH-secreting bronchial carcinoid tumors, suppressed plasma ACTH by 24 h after tumor removal, and subsequent secondary adrenal insufficiency indicating successful surgical therapy (five of five true-positive). In one patient, previous surgery was not curative and did not result in a decrease in intraoperative measurement of ACTH (one of one true-negative). It was demonstrated that a rapid ACTH immunochemiluminescence assay with a 15-min incubation time has sufficient sensitivity and precision to detect decreases in ACTH described above. These results demonstrate that complete removal of ACTH-secreting bronchial carcinoid tumors can be detected intraoperatively by a decrease in arterial ACTH by 15 min. The modification of the ACTH immunochemiluminescence assay to 15 min incubation allows the documentation of a successful tumor removal in the operating room. It may also be used to locate the tumor intraoperatively by selective pulmonary vein sampling. This protocol may be applicable to the intraoperative measurement of ACTH during pituitary microadenomectomy for Cushing's disease.
Author List
Raff H, Shaker JL, Seifert PE, Werner PH, Hazelrigg SR, Findling JWAuthors
James W. Findling MD Professor in the Medicine department at Medical College of WisconsinHershel Raff PhD Professor in the Academic Affairs department at Medical College of Wisconsin
Joseph L. Shaker MD Professor in the Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Adrenocorticotropic HormoneAdult
Aged
Bronchial Neoplasms
Carcinoid Tumor
Female
Humans
Hydrocortisone
Intraoperative Period
Male
Middle Aged