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Case Reports
. 2015 Dec 23:2015:bcr2015211520.
doi: 10.1136/bcr-2015-211520.

Possible ACTH-independent, cortisol-secreting and DHEA-secreting metastatic hepatocellular carcinoma causing Cushing's syndrome

Alan Sacerdote  1 , Taiga Inoue  1 , Nithin Thomas  2 , Gul Bahtiyar  1
Affiliations
Case Reports

Possible ACTH-independent, cortisol-secreting and DHEA-secreting metastatic hepatocellular carcinoma causing Cushing's syndrome

Alan Sacerdote et al. BMJ Case Rep. .

Abstract

Cortisol production by hepatocellular carcinoma (HCC) has not been previously reported and dehydroepiandrosterone (DHEA) secretion by HCC is rare. We report a case of a 53-year-old woman admitted with dyspnoea and headache. Serum cortisol by immunoassay (IA) was 42.3 μg/dL, urine free cortisol (UFC) by liquid chromatography mass spectrometry (LC/MS/MS) was 106.1 μg/24 h, serum DHEA by LC/MS/MS was 4886 ng/mL, serum DHEA-S by LC/MS/MS was 4477 ng/mL and plasma adrenocorticotrophic hormone (ACTH) by IA was 10 pg/mL. CT showed likely HCC metastatic to the left adrenal gland, brain and lungs. Liver and adrenal gland biopsies confirmed HCC. ACTH tumour staining was negative. High serum and UFC levels and high serum DHEA and DHEA-S with low-normal plasma ACTH and negative tumour ACTH staining suggested ACTH-independent ectopic Cushing's syndrome (CS); cortisol and DHEA being likely secreted by the HCC. To the best of our knowledge, this is the first reported case of HCC associated with CS.

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Figures

Figure 1
Figure 1
Abdominal CT image showing hepatocellular carcinoma with metastasis to left adrenal gland.
Figure 2
Figure 2
H&E tumour stain showing hepatocellular carcinoma.
Figure 3
Figure 3
Negative immunoperoxidase tumour stain for ACTH.
See this image and copyright information in PMC

References

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