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Eur J Cardiothorac Surg 2002;21:1126-1127
© 2002 Elsevier Science NL

Letter to the Editor

Reply to Filosso et al.

Chiara Dall'Asta, Luigi Santambrogio, Massimo Castellani, Bruno Ambrosi*

Istituto Policlinico San Donato Divisione di Endocrinologia e Diabetologia Via Morandi 30 20097 San Donato Milanese, Milan, Italy

Received 11 February 2002; accepted 13 February 2002.

* Corresponding author
e-mail: bruno.ambrosi{at}unimi.it

In their letter to the Editor, Filosso et al. emphasize the role of 111In-pentetreotide scintigraphy (Octreoscan) in the diagnosis and the follow-up of ectopic ACTH-dependent Cushing's syndrome (EAS). Moreover, they suggest that a positive image at Octreoscan is predictive of a successful treatment with somatostatin analogues.

We completely agree with the authors about the usefulness of functional images in the follow-up of those patients whose tumour has shown a positive tracer uptake preoperatively.

In our experience, among nine patients with EAS, CT helped to localize the lesion in 5/9 cases; Octreoscan was false negative in three, false positive in two, while it early identified two relapses, 18F-deoxyglucose positron emisson tomography (PET) was false negative in two, false positive in one and positive in one.

Furthermore, we also observed that one patient with negative Octreoscan imaging transiently improved his clinical condition when treated with somatostatin analogues.

Thus, we believe that every patient with EAS should preoperatively undergo Octreoscan, and probably also PET, but CT or MRI seem to be the best techniques to localize ectopic ACTH tumors. In addition, owing to the relative rarity of this severe condition, it would be hoped and advisable to share experiences and efforts from different Centers.





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