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In a 60-year-old woman Cushing's syndrome was induced by an ACTH producing bronchial carcinoid. In spite of the presence of an ectopic ACTH syndrome, the clinical, radiological and biochemical findings and the positive dexamethasone suppression test were compatible with Cushing's disease. Selective enucleation of an adenoma or total hypophysectomy was therefore felt to be indicated. Following total hypophysectomy, however, the Cushing's syndrome persisted and this suggested the possibility of an ectopic ACTH syndrome. As tumor localization was impossible, bilateral adrenalectomy was planned, but before this could be done the patient had to be hospitalized for staphylococcal septicemia and died. Autopsy revealed a subpleurally located bronchial carcinoid as the source of ACTH.
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