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Case Reports
. 2022 Dec 19;15(12):e247997.
doi: 10.1136/bcr-2021-247997.

ACTH-secreting metastatic prostate cancer with neuroendocrine differentiation

Bashar Hassan  1 , Yara Yazbeck  2 , Vanessa Akiki  2 , Ibrahim Salti  2 , Arafat Tfayli  3
Affiliations
Case Reports

ACTH-secreting metastatic prostate cancer with neuroendocrine differentiation

Bashar Hassan et al. BMJ Case Rep. .

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.

Keywords: Adrenal disorders; Endocrine cancer; Metabolic disorders; Prostate Cancer.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Abdominal CT illustrating liver hypo-enhancing lesions with peripheral rim enhancement indicating metastasis.
Figure 2
Figure 2
Liver biopsies (A–C) showing positive staining for synaptophysin, thyroid transcription factor-1 and ectopic adrenocorticotropic hormone, respectively.
Figure 3
Figure 3
Test to establish the cause of Cushing’s syndrome. Figure prepared by Yara Yazbeck, MD, and Vanessa Akiki, MD. HDDST, high-dose dexamethasone suppression test.
See this image and copyright information in PMC

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