endosergЭндокринная хирургияEndocrine Surgery2306-35132310-3965Типография «Печатных дел Мастер»10.14341/2306-3513-2012-4-4-10endoserg-3992Research ArticleСтатьиArticlesМетоды топической диагностики АКТГ-продуцирующих нейроэндокринных опухолей различной локализации (обзор литературы)Methods of topical diagnosis of ectopic ACTH-producing tumors of different localization (review of the literature)LatkinaN Vlatkina_enc@mail.ruDobrevaE A-KuznetsovN S-20121512201264№4 (2012)410Copyright © Latkina N.V., Dobreva E.A., Kuznetsov N.S., 20122012Latkina N.V., Dobreva E.A., Kuznetsov N.S.Latkina N.V., Dobreva E.A., Kuznetsov N.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.surg-endojournals.ru/jour/article/view/3992

Топическая диагностика АКТГ-продуцирующих нейроэндокринных опухолей – важнейший этап в обследовании больных с АКТГ-эктопическим синдромом, так как одним из основных методов лечения таких больных является хирургический. Существует множество методов топической диагностики АКТГ-продуцирующих опухолей, которые имеют свои достоинства и недостатки. В то же время до настоящего момента ни один из существующих методов исследования не гарантирует 100%-ный результат, что приводит к получению ложноположительных заключений и, как следствие, проведению необоснованного хирургического вмешательства. В статье обсуждаются основные используемые на данный момент методы визуализации АКТГ-продуцирующих опухолей, приводится их сравнительная характеристика и обсуждается оптимальный диагностический алгоритм.

Topical diagnostic methods in ACTH-producing neuroendocrine tumors with various localization. Topical diagnostic of ACTH-producing neuroendocrine tumors is a major stage in management of patients with ACTH-producing syndrome, because one of the main methods of treatment of such patients is surgical. There are several methods of topical diagnostic of ACTH-producing tumors with ectopic ocalization which have some advantages and disadvantages. At the same time until now any of existing methods of research doesn't guarantee 100% result that leads to obtaining the false positive conclusions and, as a result, carrying out unreasonable surgical operation. This report is about the main methods of topical diagnosis and their comparative characteristics. Besides possible ways to increase sensitivity and efficiency of methods and improve results are discussed in article.

АКТГ-эктопический синдромКТМРТПЭТсцинтиграфияectopic ACTH-syndromeCT scanMRTPETscintiraphyReferencesNewell-Price J., Bertagna X., Grossman A.B. et al. Cushing’s syndrome. Lancet. 2006; 367: 1605–1617.Newell-Price J., Bertagna X., Grossman A.B. et al. Cushing’s syndrome. Lancet. 2006; 367: 1605–1617.Aniszewski J.P., Young W.F., Thompson G.B. et al. Cushing syndrome due to ectopic adrenocorticotropic hormone secretion. Wld J. Surg. 2001; 25: 934–940.Aniszewski J.P., Young W.F., Thompson G.B. et al. Cushing syndrome due to ectopic adrenocorticotropic hormone secretion. Wld J. Surg. 2001; 25: 934–940.Ilias I., Torpy D.J., Pacak K., Mullen N. et al. Cushing’s syndrome due to ectopic corticotropin secretion: twenty years’ experience at the National Institutes of Health. J. Clin. Endocrinol. Metab. 2005; 90: 4955–4962.Ilias I., Torpy D.J., Pacak K., Mullen N. et al. Cushing’s syndrome due to ectopic corticotropin secretion: twenty years’ experience at the National Institutes of Health. J. Clin. Endocrinol. Metab. 2005; 90: 4955–4962.Scully R.E., Mark E.J., McNneely W.F. Case 4-2000. The New Engl. J. Med. 2000; 10: 414–420.Scully R.E., Mark E.J., McNneely W.F. Case 4-2000. The New Engl. J. Med. 2000; 10: 414–420.Rosch T., Lightdale C.J., Botet J.F. et al. Localization of pancreatic endocrine tumors by endoscopic ultrasonography. N. Engl. J. Med. 1992; 326: 1721–1726.Rosch T., Lightdale C.J., Botet J.F. et al. Localization of pancreatic endocrine tumors by endoscopic ultrasonography. N. Engl. J. Med. 1992; 326: 1721–1726.Javorsky B.R., Carroll T.B., Findling J.W. Differential Diagnosis of Cushing’s Syndrome. New York: Springer, 2011: 85–107.Javorsky B.R., Carroll T.B., Findling J.W. Differential Diagnosis of Cushing’s Syndrome. New York: Springer, 2011: 85–107.Sahdev A., Rodney H., Reznek J. et al. Imaging in Cushing’s syndrome. Arq. Bras. Endocrinol. Metab. 2007; 51/8: 1319–1328.Sahdev A., Rodney H., Reznek J. et al. Imaging in Cushing’s syndrome. Arq. Bras. Endocrinol. Metab. 2007; 51/8: 1319–1328.Horton K.M., Kamel I., Hofmann L. et al. Carcinoid tumors of the small bowel: a multitechnique imaging approach. Am. J. Roentgenol. 2004; 182: 559–567.Horton K.M., Kamel I., Hofmann L. et al. Carcinoid tumors of the small bowel: a multitechnique imaging approach. Am. J. Roentgenol. 2004; 182: 559–567.Isidori A.M., Kaltsas G.A., Pozza C. et al. The ectopic adrenocorticotropin syndrome: clinical features, diagnosis, management, and long-term follow-up. J. Clin. Endocrinol. Metab. 2006; 91: 371–377.Isidori A.M., Kaltsas G.A., Pozza C. et al. The ectopic adrenocorticotropin syndrome: clinical features, diagnosis, management, and long-term follow-up. J. Clin. Endocrinol. Metab. 2006; 91: 371–377.Krakoff J., Koch C.A., Calis K.A. et al. Use of a parenteral propylene glycol-containing etomidate preparation for the long-term management of ectopic Cushing' s syndrome. J. Clin. Endocrinol. Metab. 2001; 86: 4104–4108.Krakoff J., Koch C.A., Calis K.A. et al. Use of a parenteral propylene glycol-containing etomidate preparation for the long-term management of ectopic Cushing' s syndrome. J. Clin. Endocrinol. Metab. 2001; 86: 4104–4108.Fasshauer M., Lincke T., Witzigmann H. et al. Ectopic Cushing' syndrome caused by a neuroendocrine carcinoma of the mesentery. BMC Cancer 2006; 6: 108.Fasshauer M., Lincke T., Witzigmann H. et al. Ectopic Cushing' syndrome caused by a neuroendocrine carcinoma of the mesentery. BMC Cancer 2006; 6: 108.Beuschlein F., Hammer G.D. Ectopic pro-opiomelanocortin syndrome. Endocrinol. Metab. Clin. North Am. 2002; 31: 191–234.Beuschlein F., Hammer G.D. Ectopic pro-opiomelanocortin syndrome. Endocrinol. Metab. Clin. North Am. 2002; 31: 191–234.Tsagarakis S., Christoforaki M., Giannopoulou H. et al. A reappraisal of the utility of somatostain receptor scintigraphy in patients with ectopic adrenocorticotropin Cushing’s syndrome. J. Clin. Endocrinol. Metab. 2003; 88: 4754–4747.Tsagarakis S., Christoforaki M., Giannopoulou H. et al. A reappraisal of the utility of somatostain receptor scintigraphy in patients with ectopic adrenocorticotropin Cushing’s syndrome. J. Clin. Endocrinol. Metab. 2003; 88: 4754–4747.Pacak K., Ilias I., Chen C.C. et al. The role of [18F]fluorodeoxyglucose positron emission tomography and [111In]diethylenetriaminepentaacetate-D-Phe-pentetreotide scintigraphy in the localization of ectopic adrenocorticotropinsecreting tumors causing Cushing’s syndrome. J. Clin. Endocrinol. Metab. 2004; 89: 2214–2221.Pacak K., Ilias I., Chen C.C. et al. The role of [18F]fluorodeoxyglucose positron emission tomography and [111In]diethylenetriaminepentaacetate-D-Phe-pentetreotide scintigraphy in the localization of ectopic adrenocorticotropinsecreting tumors causing Cushing’s syndrome. J. Clin. Endocrinol. Metab. 2004; 89: 2214–2221.Waintrop C., Tenenbaum F., Coulot J. et al. Image in endocrinology: localization of an occult adrenocorticotropinsecreting carcinoid tumor with somatostatin receptor scintigraphy using single-photon emission computed tomography/computed tomographic image scanning. J. Clin. Endocrinol. Metab. 2006; 91: 3271–3272.Waintrop C., Tenenbaum F., Coulot J. et al. Image in endocrinology: localization of an occult adrenocorticotropinsecreting carcinoid tumor with somatostatin receptor scintigraphy using single-photon emission computed tomography/computed tomographic image scanning. J. Clin. Endocrinol. Metab. 2006; 91: 3271–3272.Sookur P.A., Sahdev A., Rockall A.G. et al. Imaging in covert ectopic ACTH secretion: a CT pictorial review. Eur. Radiol. 2009; 19: 1069–1078.Sookur P.A., Sahdev A., Rockall A.G. et al. Imaging in covert ectopic ACTH secretion: a CT pictorial review. Eur. Radiol. 2009; 19: 1069–1078.Shrager J.B., Wright C.D., Wain J.C. et al. Bronchopulmonary carcinoid tumors associated with Cushing's syndrome: a more aggressive variant of typical carcinoid. J. Thorac. Cardiovasc. Surg. 1997; 114: 367–375.Shrager J.B., Wright C.D., Wain J.C. et al. Bronchopulmonary carcinoid tumors associated with Cushing's syndrome: a more aggressive variant of typical carcinoid. J. Thorac. Cardiovasc. Surg. 1997; 114: 367–375.Torpy D.J., Chen C.C., Mullen N. et al. Lack of utility of (111)In-pentetreotide scintigraphy in localizing ectopic ACTH producing tumors: follow-up of 18 patients. J. Clin. Endocrinol. Metab. 1999; 84: 1186–1192.Torpy D.J., Chen C.C., Mullen N. et al. Lack of utility of (111)In-pentetreotide scintigraphy in localizing ectopic ACTH producing tumors: follow-up of 18 patients. J. Clin. Endocrinol. Metab. 1999; 84: 1186–1192.Castellani M., Ambrosi B. Difficulties in diagnosis and treatment of ectopic ACTH-producing tumors of the chest. Eur. J. Cardiothorac. Surg. 2002; 21: 149–151.Castellani M., Ambrosi B. Difficulties in diagnosis and treatment of ectopic ACTH-producing tumors of the chest. Eur. J. Cardiothorac. Surg. 2002; 21: 149–151.Sundin A., Garske U., Orlefors H. Nuclear imaging of neuroendocrine tumours. Best Practice & Research Clinical Endocrinology & Metabolism 2007; 21: 69–85.Sundin A., Garske U., Orlefors H. Nuclear imaging of neuroendocrine tumours. Best Practice & Research Clinical Endocrinology & Metabolism 2007; 21: 69–85.Kaltsas G., Korbonits M., Heintz E. et al. Comparison of somatostatin analog and meta-iodobenzylguanidine radionuclides in the diagnosis and localization of advanced neuroendocrine tumors. J. Clin. Endocrinol. Metab. 2001; 86: 895–902.Kaltsas G., Korbonits M., Heintz E. et al. Comparison of somatostatin analog and meta-iodobenzylguanidine radionuclides in the diagnosis and localization of advanced neuroendocrine tumors. J. Clin. Endocrinol. Metab. 2001; 86: 895–902.Van der Harst E., De Herder W.W., Bruining H.A. et al. [123I]Metaiodobenzylguanidine and [111In]Octreotide uptake in benign and malignant pheochromocytomas. J. Clin. Endocrinol. Metab. 2001; 86: 685–693.Van der Harst E., De Herder W.W., Bruining H.A. et al. [123I]Metaiodobenzylguanidine and [111In]Octreotide uptake in benign and malignant pheochromocytomas. J. Clin. Endocrinol. Metab. 2001; 86: 685–693.De Herder W.W., Lamberts S.W. Octapeptide somatostatinanalogue therapy of Cushing's syndrome. Postgrad. Med. J. 1999; 75: 65–66.De Herder W.W., Lamberts S.W. Octapeptide somatostatinanalogue therapy of Cushing's syndrome. Postgrad. Med. J. 1999; 75: 65–66.Xu H., Zhang M., Zhai G. et al. The role of integrated 18F-FDG PET/CT in identification of ectopic ACTH secretion tumors. Endocrinology. 2009; 36: 385–391.Xu H., Zhang M., Zhai G. et al. The role of integrated 18F-FDG PET/CT in identification of ectopic ACTH secretion tumors. Endocrinology. 2009; 36: 385–391.Zemskova M.S., Gundabolu B., Sinaii N. et al. Utility of various functional and anatomic imaging modalities for detection of ectopic adrenocorticotropin-secreting tumors. J. Clin. Endocrinol. Metab. 2010; 95: 1207–1219.Zemskova M.S., Gundabolu B., Sinaii N. et al. Utility of various functional and anatomic imaging modalities for detection of ectopic adrenocorticotropin-secreting tumors. J. Clin. Endocrinol. Metab. 2010; 95: 1207–1219.De Perrot M., Spiliopoulos A., Fischer S. et al. Neuroendocrine carcinoma (carcinoid) of the thymus associated with Cushing’s syndrome. Ann. Thorac. Surg. 2002; 73: 675–681.De Perrot M., Spiliopoulos A., Fischer S. et al. Neuroendocrine carcinoma (carcinoid) of the thymus associated with Cushing’s syndrome. Ann. Thorac. Surg. 2002; 73: 675–681.Rufini V., Calcagni M.L., Baum R.P. Imaging of neuroendocrine tumors. Semin. Nucl. Med. 2006; 36: 228–247.Rufini V., Calcagni M.L., Baum R.P. Imaging of neuroendocrine tumors. Semin. Nucl. Med. 2006; 36: 228–247.

The authors declare that there are no conflicts of interest present.