ACTH-secreting metastatic prostate cancer with neuroendocrine differentiation
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BMJ Publishing Group
Abstract
Cushing's syndrome (CS) due to ectopic adrenocorticotropic hormone (ACTH) secretion (EAS) can result from a variety of tumours and rarely from those of prostatic origin. We present a male patient in his early 60s with ACTH-secreting metastatic prostate adenocarcinoma with neuroendocrine differentiation (ICD-O code 8574/3) years after prostatectomy and androgen-deprivation therapy, initially presenting with Cushingoid features. After open radical prostatectomy and bilateral orchiectomy for disease recurrence, the patient was found to have metastatic liver and bone lesions highly suggestive of metastatic prostatic cancer. About 10% of cells on liver biopsy expressed ACTH, a finding consistent with EAS as the cause of CS. His stay was complicated with multiple infections and ultimate death. Hence, we report a case of metastatic prostate adenocarcinoma with neuroendocrine differentiation who presented with CS. We also emphasize the importance of adequate and timely treatment. © 2022 BMJ Publishing Group Limited. Published by BMJ.
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Keywords
Adrenal disorders, Endocrine cancer, Metabolic disorders, Prostate cancer, Acth syndrome, ectopic, Adenocarcinoma, Adrenocorticotropic hormone, Androgen antagonists, Cell differentiation, Cushing syndrome, Humans, Male, Neoplasm recurrence, local, Prostatic neoplasms, Aldosterone, Alfacalcidol, Amlodipine, Calcium, Calcium carbonate, Corticotropin, Dexamethasone, Docetaxel, Enzalutamide, Homeobox protein nkx 2.1, Ketoconazole, Metyrapone, Mitotane, Parathyroid hormone, Phosphate, Spironolactone, Antiandrogen, Adult, Albumin to creatinine ratio, Albuminuria, Androgen deprivation therapy, Article, Bacteremia, Bone metastasis, Case report, Clinical article, Computer assisted tomography, Dexamethasone suppression test, Estimated glomerular filtration rate, Glucose blood level, Human, Human tissue, Hypercortisolism, Hypocalcemia, Hypotension, Liver biopsy, Liver metastasis, Metabolic disorder, Middle aged, Neurosecretory cell, Nuclear magnetic resonance imaging, Potassium blood level, Prostatectomy, Protein expression, Complication, Ectopic corticotropin production, Prostate tumor, Tumor recurrence