" NlmCategory=: Resection of primary @entity5 is the management of choice in @entity1 with @entity11060 . However, @entity5 may remain unidentified or occult in spite of extensive efforts at trying to locate them. This can, therefore, pose a major management issue as uncontrolled hypercortisolaemia can lead to life-threatening infections. We present the case of a 66-year-old gentleman with @entity11060 from an occult primary @entity5 with multiple significant complications from hypercortisolaemia. Ectopic nature of his ACTH-dependent @entity699 was confirmed by non-suppression with high-dose @entity619 suppression test and bilateral inferior petrosal sinus sampling. The primary ectopic source remained unidentified in spite of extensive anatomical and functional imaging studies, including CT scans and Dotatate-PET scan. Medical adrenolytic treatment at maximum tolerated doses failed to control his hypercortisolaemia, which led to recurrent @entity6177 , requiring multiple surgical interventions. Laparoscopic bilateral adrenalectomy was considered but decided against given concerns of technical difficulties due to recurrent @entity1320 and his moribund state. Eventually, @entity285 ablation of adrenal glands by retrograde adrenal vein approach was attempted, which resulted in biochemical remission of @entity699 . Our case emphasizes the importance of aggressive management of hypercortisolaemia in order to reduce the associated morbidity and mortality and also demonstrates that techniques like percutaneous adrenal ablation using a retrograde venous approach may be extremely helpful in @entity1 who are otherwise unable to undergo bilateral adrenalectomy. LEARNING POINTS: Evaluation and management of @entity1 with @entity11060 from an unidentified primary @entity5 can be very challenging.Persisting hypercortisolaemia in this setting can lead to debilitating and even life-threatening complications and hence needs to be managed aggressively.Bilateral adrenalectomy should be considered when medical treatment is ineffective or poorly tolerated.Percutaneous adrenal ablation may be considered in @entity1 who are otherwise unable to undergo bilateral adrenalectomy.

A case of severe XXXX from an occult primary - diagnostic and management dilemmas.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity11060 :: ('MESH:D000182', 'Disease') :: ['ectopic ACTH syndrome'] @entity5 :: ('MESH:D009369', 'Disease') :: ['tumours', 'tumour'] @entity6177 :: ('MESH:D018784', 'Disease') :: ['intra-abdominal and pelvic abscesses'] @entity699 :: ('MESH:D003480', 'Disease') :: ["Cushing's syndrome"] @entity619 :: ('MESH:D003907', 'Chemical') :: ['dexamethasone'] @entity1320 :: ('MESH:D059413', 'Disease') :: ['intra-abdominal infections'] @entity285 :: ('D000431', 'Chemical') :: ['alcohol']
@entity11060 :: (MESH:D000182,Disease) :: ['ectopic ACTH syndrome']
