Opportunistic infections in patients with ectopic ACTH-secreting tumors

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The ability of glucocorticoids to alter normal immunity and resistance to infection is well recognized, but has been infrequently reported as a complication of ectopic ACTH-secreting tumors.1, 2 We recently treated two such patients in whom opportunistic infections developed; one with Nocardia asteroides and one with Aspergillus fumigatus. In the same 3 years, 19 other patients have had presenting features of Cushing’s syndrome of other causes. In none of these patients did serious opportunistic infections develop. In the 38 patients from 1951 to 1973 with Cushing’s disease previously reported,3 there were no cases of opportunistic infection. Also, we have unpublished data on an additional 20 cases of Cushing’s syndrome from 1973 to 1977. Again, no serious infections occurred. Thus, we agree with Anthony and Greco4 that the natural history of Cushing’s syndrome appears to have changed since the classic series of Plotz et al.5 Since we have encountered no opportunistic infections in the other 77 patients with endogenous Cushing’s syndrome from 1951 to 1980, we postulate that the difference is due to a dose-dependent immunosuppression by circulating corticosteroids.

Our experience with the 21 patients with presenting symptoms of Cushing’s syndrome between July 1977 and July 1980 is summarized (Table). The methods used for determining ACTH and Cortisol have been reported.3 Several of the urinary free cortisol values were determined by a fluorometric method, which has since been supplanted by radioimmunoassay. The values of the fluorometric determinations have been adjusted to correspond with the newer methods for purposes of comparison.

Case . . .



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