ECTOPIC CUSHING'S SYNDROME: A REVIEW OF DIAGNOSTIC AND THERAPEUTIC STRATEGIES

Abstract

Ectopic Cushing's Syndrome (ECS) is a rare condition characterized by the excessive production of adrenocorticotropic hormone by non-pituitary neoplasms, resulting in severe hypercortisolism and high morbidity and mortality. The clinical presentation is usually more aggressive compared to Cushing's disease of pituitary origin, with frequently intense metabolic, infectious, and muscular manifestations. Diagnosis represents a significant challenge, requiring the combination of hormonal tests to confirm hypercortisolism and specific methods for etiological differentiation. This narrative review aims to critically analyze the main diagnostic and therapeutic strategies for Ectopic Cushing's Syndrome. The bibliographic search was conducted in national and international databases, including original studies, reviews, and relevant guidelines. The results show that the combination of laboratory tests, conventional imaging methods, and functional imaging techniques is fundamental for identifying the ectopic source of ACTH. In therapeutic management, surgical resection of the ectopic tumor, when feasible, is the approach of choice; however, pharmacological control of hypercortisolism and, in selected cases, bilateral adrenalectomy play an essential role in reducing complications and improving prognosis. It is concluded that the management of ECS requires a multidisciplinary and individualized approach, with diagnostic and therapeutic advances being crucial for optimizing clinical outcomes.