Long-term cyclic ectopic adrenocorticotropic hormone syndrome with extreme fluctuations and adrenal insufficiency. (PubMed, JCEM Case Rep) - Oct 15, 2026 - "A 77-year-old woman presented with worsening glycemic control and hypokalemia and was found to have adrenocorticotropic hormone (ACTH)-dependent hypercortisolism with loss of diurnal cortisol variation and failure of suppression on low- and high-dose dexamethasone suppression tests. During treatment with ketoconazole, mitotane, and osilodrostat, the patient experienced recurrent significant hypocortisolic episodes, some of which were likely treatment-associated and required hydrocortisone replacement therapy. This case highlights an exceptionally prolonged course of cyclic ectopic ACTH syndrome characterized by extreme hormonal oscillation, reversible adrenal hyperplasia, and recurrent hypocortisolism, emphasizing the importance of long-term biochemical surveillance and individualized therapeutic adjustment."
Journal • Cushing's Disease • Endocrine Disorders • Nephrology • Renal Disease
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Gwanpyo Koh; Hyounjung Chin; Sang Ah Lee; Soon Young Choi; Soyeon Yoo
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