Ectopic Cushing's Syndrome: A Race Against Time

Cushing's syndrome is characterized by a phenotype resulting from cortisol excess. To manage Cushing's syndrome, the etiology must be defined. Cushing's syndrome is broadly divided into adrenocorticotrophic hormone-dependent and adrenocorticotrophic hormone-independent Cushing's syndrome. Adrenocorticotrophic hormone-dependent Cushing's syndrome is further subdivided as pituitary adrenocorticotrophic hormone-secreting Cushing's disease and ectopic Cushing's syndrome where adrenocorticotrophic hormone is secreted from a location outside the pituitary. Ectopic adrenocorticotrophic hormone syndrome can be a challenging situation as the patients are often sick and the adrenocorticotrophic hormone source is not always obvious. The challenge is even tougher in case of infants and children. Here, we present one such case of ectopic adrenocorticotrophic hormone syndrome we encountered recently, had difficulties in managing her, and unfortunately lost the child. The source of adrenocorticotrophic hormone was a sacrococcygeal teratoma.