Pulmonary neuroendocrine tumour-associated ectopic Cushing’s syndrome: diagnostic challenges and multidisciplinary management

Ectopic ACTH secretion should be suspected in cases of severe, rapidly progressive hypercortisolism with marked hypokalaemia. Combined therapy with metyrapone and ketoconazole, along with hydrocortisone blockade and replacement, allows for rapid and safe cortisol control before surgery. 68Ga-DOTATOC PET-CT is essential for accurate localisation and staging of neuroendocrine tumours with ectopic ACTH production. Multidisciplinary management involving endocrinology, nuclear medicine, radiology, psychiatry, nutrition and thoracic surgery is crucial for successful outcomes. Early identification and aggressive management of metabolic and psychiatric complications are key to full recovery.