Utility of gel filtration chromatography in evaluating successful resection of ectopic adrenocorticotropic hormone-producing tumor: a case report and literature review

Ectopic adrenocorticotropic hormone (ACTH) syndrome resulting from ectopically secreting tumors poses a significant clinical challenge. Accurately identifying the tumor source and achieving curative resection are pivotal for patient prognosis; however, achieving these objectives is often complicated by complex ACTH secretion patterns. High-molecular-weight ACTH, frequently secreted by ectopic ACTH-producing tumors, is distinct from the conventional 39-amino-acid ACTH (ACTH_1-39) produced by the pituitary gland. We believe that the evaluation of ACTH characteristics using gel filtration chromatography (GFC) can be used to determine whether curative resection can be achieved. A patient with ectopic ACTH syndrome owing to a thymic neuroendocrine tumor was enrolled in this study. Despite a marked reduction in plasma ACTH levels post-surgery, the levels remained above the detection threshold, raising concerns regarding potential residual tumor activity. To investigate this further, GFC was employed to differentiate between ACTH_1-39 and high-molecular-weight ACTH in postoperative plasma samples. High-molecular-weight ACTH was predominant in the postoperative samples, whereas preoperative peripheral blood was primarily composed of ACTH_1-39. These findings suggest that sustained low-level ACTH post-surgery was likely owing to a delayed clearance of high-molecular-weight ACTH rather than a residual tumor activity. This interpretation is supported by the patient's favorable postoperative course and long-term follow-up, which showed no recurrence. This case study highlights the novel potential of GFC for aiding clinical decision-making.