Inclusion Criteria

- INCLUSION CRITERIA:

All eligible patients are invited to participate in this protocol. Patients are adults
with possible ectopic Cushing syndrome. Since both men and women are affected with
ectopic Cushing syndrome, both sexes are studied. All ethnic and racial groups are at
risk and will be included. Patients must be willing to return to NIH for follow-up
studies.

EXCLUSION CRITERIA:

Pregnant or lactating women.

Children (age less than18) are excluded.

Patients with any severe active infection.

Patients with clinically significantly impaired cardiovascular (e.g., history of
abnormally low ejection fraction, the presence of moderate pulmonary fluid overload or leg
edema, and blood pressure over 190/100), abnormal coagulation (PT and PTT elevated by 30
percent above the normal values), hematopoietic (hematocrit less than 30 percent,
hemoglobin below 10 g/dl, white count below 3000 K/UL, and platelets below 100,000
K/mm(3)), hepatic (liver enzymes elevated by 3-fold above normal values) or renal function
(plasma creatinine level over 2.0).

Patients with impaired mental capacity or markedly abnormal psychiatric evaluation that
precludes informed consent.

Patients with body weight over 136 kg, which is the limit for the tables used in the
scanning areas.

Patients with combined blood withdrawal, during the six weeks preceding the study, of
greater than 450 ml.

Patients with known allergy to [111In-DTPA-D-Phe]-pentetreotide or other somatostatin
analogues.

Patients more than 70 years of age due to other possible existing diseases which may
significantly affect appropriate initial work-up and post-operative morbidity and
mortality.

Patients with strong evidence for Cushing disease. This includes those with positive IPSS
or a lesion on pituitary MRI.

Patients taking medications that alter CYP3A4 activity will not be eligible for the
mifepristone study, since this P450 system metabolizes mifepristone.