8767 Ectopic Cushing's Disease

Abstract Disclosure: V.A. Kothari: None. Here we present the diagnostic journey of a patient with Cushings syndrome attributed to a rare and elusive culprit—a neuroendocrine tumor that aberrantly produces adrenocorticotropic hormone (ACTH). An 83-year-old female with PMH of Graves disease well-controlled on methimazole 5 mg daily presented w/ AMS 1, respectively which ruled out hyperaldosteronism. Her insulin requirements had significantly escalated. Given the patients skin changes with petechiae along with the findings above, the patient underwent a low-dose DST twice which showed elevated AM cortisol of 76.4 s active Cushings disease was due to residual tumor or other areas of carcinoid as the lung nodule was dotatate and FDG negative. Given the active Cushings disease, ketoconazole 200 mg BID was restarted. Her condition continued to worsen despite escalating doses of ketoconazole. Due to proximal myopathy, she was unable to ambulate on her own requiring significant assistance. Definitive treatment was discussed with the patient and her family given the progressive functional decline. Broached adrenal ablation versus adrenalectomy was discussed and bilateral adrenalectomy was eventually decided upon and scheduled. This case highlights the rare occurrence of ectopic ACTH producing neuroendocrine tumors causing Cushings syndrome. It underscores the need for advanced diagnostic approaches and collaborative healthcare efforts in managing uncommon endocrine disorders. Presentation: 6/2/2024