Iatrogenic Cushing's syndrome on 18F-FDG-PET/CT: A pitfall in metabolic assessment of oncologic response. 2021

Harit Kapoor, and Wesley Hatfield, and Riham El Khouli, and Aurela Xhafa Clark
Department of Radiology, University of Kentucky Chandler Medical Center, 800 Rose Street, Lexington, KY 40536, USA. Electronic address: haritkapoor@gmail.com.

Iatrogenic Cushing's syndrome has very well-known stigmata on physical examination but can pose a diagnostic challenge when it rarely presents radiologically. We present a classic albeit rarely encountered imaging appearance of Iatrogenic Cushing's on 18F-FDG-PET/CT, with diffuse subcutaneous white adipose proliferation and metabolic activation in a 7-year old patient one-month after starting a high dose steroid regimen for lymphoma. There was an extreme shift in the expected FDG biodistribution with dominant localization to the subcutaneous adipose tissue. This metabolic shift led to sub-threshold visceral biodistribution, rendering the scan non-diagnostic with regards to assessment of oncologic response. Aside from detailing the characteristic imaging findings of Iatrogenic Cushing's and its clinical importance, we discuss the physiologic basis of this imaging pattern and the rarer differential diagnosis to consider when this pattern of uptake is encountered on 18F-FDG-PET/CT.

UI MeSH Term Description Entries
D007049 Iatrogenic Disease Any adverse condition in a patient occurring as the result of treatment by a physician, surgeon, or other health professional, especially infections acquired by a patient during the course of treatment. Hospital-Acquired Condition,Condition, Hospital-Acquired,Conditions, Hospital-Acquired,Disease, Iatrogenic,Diseases, Iatrogenic,Hospital Acquired Condition,Hospital-Acquired Conditions,Iatrogenic Diseases
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D003480 Cushing Syndrome A condition caused by prolonged exposure to excess levels of cortisol (HYDROCORTISONE) or other GLUCOCORTICOIDS from endogenous or exogenous sources. It is characterized by upper body OBESITY; OSTEOPOROSIS; HYPERTENSION; DIABETES MELLITUS; HIRSUTISM; AMENORRHEA; and excess body fluid. Endogenous Cushing syndrome or spontaneous hypercortisolism is divided into two groups, those due to an excess of ADRENOCORTICOTROPIN and those that are ACTH-independent. Cushing's Syndrome,Hypercortisolism,Syndrome, Cushing,Syndrome, Cushing's
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000072078 Positron Emission Tomography Computed Tomography An imaging technique that combines a POSITRON-EMISSION TOMOGRAPHY (PET) scanner and a CT X RAY scanner. This establishes a precise anatomic localization in the same session. CT PET,CT PET Scan,PET CT Scan,PET-CT,PET-CT Scan,Positron Emission Tomography-Computed Tomography,CT PET Scans,CT Scan, PET,CT Scans, PET,PET CT Scans,PET Scan, CT,PET Scans, CT,PET-CT Scans,Scan, CT PET,Scan, PET CT,Scan, PET-CT,Scans, CT PET,Scans, PET CT,Scans, PET-CT
D014018 Tissue Distribution Accumulation of a drug or chemical substance in various organs (including those not relevant to its pharmacologic or therapeutic action). This distribution depends on the blood flow or perfusion rate of the organ, the ability of the drug to penetrate organ membranes, tissue specificity, protein binding. The distribution is usually expressed as tissue to plasma ratios. Distribution, Tissue,Distributions, Tissue,Tissue Distributions
D019788 Fluorodeoxyglucose F18 The compound is given by intravenous injection to do POSITRON-EMISSION TOMOGRAPHY for the assessment of cerebral and myocardial glucose metabolism in various physiological or pathological states including stroke and myocardial ischemia. It is also employed for the detection of malignant tumors including those of the brain, liver, and thyroid gland. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1162) 18F Fluorodeoxyglucose,18FDG,2-Fluoro-2-deoxy-D-glucose,2-Fluoro-2-deoxyglucose,Fludeoxyglucose F 18,18F-FDG,Fluorine-18-fluorodeoxyglucose,Fluorodeoxyglucose F 18,2 Fluoro 2 deoxy D glucose,2 Fluoro 2 deoxyglucose,F 18, Fludeoxyglucose,F 18, Fluorodeoxyglucose,F18, Fluorodeoxyglucose,Fluorine 18 fluorodeoxyglucose,Fluorodeoxyglucose, 18F

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