Cushings Syndrome

Ectopic production of adrenocorticotrophic hormone (ACTH) by renal cell carcinoma has been reported. However, of the 232 patients with Cushing's syndrome reported, three of them were found to have hyperneph-roma: one patient had an adrenal adenoma as well as a renal tumor, another had an incidental renal tumor found during adrenalectomy, and the other had a lapse of 21 years between the finding of increased ACTH production and renal cell carcinoma (Riggs and Sprague 1961). The mechanism of Cushing's syndrome is the enzymatic conversion of inactive proopiomelanocortin (POMC) to ACTH by the tumor. This leads to symptoms of cortisol excess, including weakness, muscle atrophy, fatigue, hypertension, and glucose intolerance. These symptoms resolved following nephrectomy (Wa-tanobe et al. 1988).

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