Document Detail


Pneumocystis carinii pneumonia associated with a rapid reduction of cortisol level in a patient with ectopic ACTH syndrome treated by octreotide and ketoconazole.
MedLine Citation:
PMID:  10826524     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
A case is herein reported of pneumocystis carinii pneumonia in a 60-year-old female patient with ectopic production of ACTH at a position 2 cm superior to her right clavicle, revealed in an octreotide scan. Her extremely high plasma ACTH and cortisol levels (460 pg/ml and 80 microg/dl, respectively) were markedly decreased with the combined treatment of octreotide (300 microg/d) and ketoconazole (600 mg/d). As her serum cortisol concentration decreased, pneumocystis carinii pneumonia occurred on the third day of treatment. A secondary E. coli infection was superimposed and the patient died of disseminated intravascular coagulation and adult respiratory distress syndrome. This case suggests that primary prophylaxis for pneumocystis carinii infection should be initiated before cortisol lowering therapy, especially when the plasma cortisol concentration is excessively high, and that early adjunctive glucocorticoid therapy can reduce the acute mortality in patients with endogenous Cushing's syndrome and Pneumocystis carinii pneumonia. This case study would also like to point out that plasma ACTH and cortisol levels were decreased effectively by the combination of octreotide and ketoconazole in this instance of ectopic ACTH syndrome.
Authors:
D S Kim; S K Park; W H Choi; T W Kim; Y Y Choi; S C Jeon; J S Ryu
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association     Volume:  108     ISSN:  0947-7349     ISO Abbreviation:  Exp. Clin. Endocrinol. Diabetes     Publication Date:  2000  
Date Detail:
Created Date:  2000-08-10     Completed Date:  2000-08-10     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9505926     Medline TA:  Exp Clin Endocrinol Diabetes     Country:  GERMANY    
Other Details:
Languages:  eng     Pagination:  146-50     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea. dskim@hmc.hanayng.ac.kr
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MeSH Terms
Descriptor/Qualifier:
ACTH Syndrome, Ectopic / drug therapy*
Adrenocorticotropic Hormone / blood
Disseminated Intravascular Coagulation / etiology
Escherichia coli Infections / etiology
Fatal Outcome
Female
Humans
Hydrocortisone / blood*
Ketoconazole / adverse effects*,  therapeutic use
Middle Aged
Octreotide / adverse effects*,  therapeutic use
Pneumonia, Pneumocystis / etiology*
Respiratory Distress Syndrome, Adult / etiology
Chemical
Reg. No./Substance:
50-23-7/Hydrocortisone; 65277-42-1/Ketoconazole; 83150-76-9/Octreotide; 9002-60-2/Adrenocorticotropic Hormone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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