Metyrapone for Delirium Due to Cushing's Syndrome Induced by Occult Ectopic Adrenocorticotropic Hormone Secretion

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Sir: Cushing’s syndrome secondary to ectopic adrenocorticotropic hormone (ACTH) syndrome is rare. Ectopic ACTHdependent Cushing’s syndrome is encountered in 2 forms, the classic overt ectopic ACTH syndrome and "occult" ectopic ACTH-secreting tumors.¹ Occult ectopic ACTH-secreting tumors are often small, and their detection requires meticulous examination. Despite recent technological advances, including inferior petrosal sinus sampling and the corticotropin-releasing hormone (CRH) stimulation test, localization of the tumor remains difficult.^1-3