A 25-year-old Arabic woman presented to the emergency department of our medical facility with rapid onset of headache, flaring acne and hirsutism, facial puffiness, weight gain and paroxysmal myopathy, and paranoiac thoughts of rape and sexual intimidation. Her physical examination revealed pronounced facial acne and hirsutism, oily skin, moon face, buffalo hump, and classical Cushing's syndrome purplish skin striae in the abdominal, axillary, and flank regions. Her blood pressure was 150/90 mmHg. Table presents the patient's relevant endocrine profile. High-dose (2 mg four times daily) dexamethasone failed to suppress both serum cortisol and urinary free cortisol (UFC) levels. Her serum testosterone, 5-dehydroepiandrosterone sulfate, and 17-OH progesterone levels were within normal limits. Chest computed tomography revealed a 22 mm × 15 mm × 10 mm mass in the upper segment of the left lower pulmonary lobe. No adrenal mass was detected. She underwent a left lower lung lobectomy. The histopathological examination showed a typical carcinoid tumor without mitotic figures or necrosis and with positive immunohistochemical stains for synaptophysin, neuron-specific enolase, and chromogranin A, as well as strong positive staining for ACTH. The patient became completely free of symptoms with abnormal, though decreasing, UFC levels. A year and a half after surgery she regained weight. Her physical examination confirmed moon face and re-darkening of previous striae. Her UFC levels were high and remained unsuppressed by either low or high doses of dexamethasone. Computed tomography of the chest and abdomen were normal, as was subsequent pituitary tomography. An indium-111 pentetreotide scan obtained to locate an occult focus of the carcinoid revealed a hot focus in the left lower pulmonary lobe and the upper right mediastinum. Treatment with steroid synthesis blockers was initiated. Mediastinal and paratracheal histopathology of lymph node material obtained by performing a thoracoscopy showed a metastatic carcinoid. Following treatment with octreotide LAR 30 mg/month, she became symptom-free. Her endocrine laboratory results normalized. Almost three years after surgery, while undergoing octreotide LAR treatment, the patient became pregnant. She refused our recommendation to discontinue octreotide LAR therapy during the first trimester, as is routine []. Rather, she insisted on continuing octreotide LAR for the duration of the pregnancy because of its effectiveness in maintaining disease remission. A healthy full-term baby was born. Two and three years later, respectively, our patient delivered two more healthy full-term babies. All three deliveries were by cesarean section. Octreotide LAR treatment was continued throughout this time period. Recent routine follow-up chest tomography 10 years after the patient's initial presentation revealed normal mediastinal lymph nodes, with permanent post-surgical changes at the basal portion of the left lung. The result of a concomitant test for urine 5-hydroxyindoleacetic acid was 6.9 mg/day, which is within normal limits (1 to 7 mg/day). An immunohistochemistry assay was performed to determine the somatostatin receptor (SSTR) sub-types in the tissue of the original carcinoid in the lung lobe as previously described []. The carcinoid tumor tested positive for SSTR types 2A and 2B and negative for SSTR types 1, 3, 4, and 5. The samples taken from the lymph node metastases were inadequate for SSTR immunohistochemistry. Our patient's three babies had normal growth patterns during 128 months of follow-up.