Endocrinol Metab.  2012 Sep;27(3):237-243. 10.3803/EnM.2012.27.3.237.

A Case of Ectopic ACTH Syndrome Associated with Metastatic Prostate Cancer

• Kim EK
• Kwak SH
• Ahn HY
• Khang AR
• Park HJ
• Park SY
• Lee SE
• Jang HC
• Kim SY
• Park YJ

• KMID: 2282409
• DOI: http://doi.org/10.3803/EnM.2012.27.3.237

Abstract

Ectopic adrenocorticotropic hormone (ACTH) syndrome is mostly associated with neuroendocrine tumors and small cell carcinoma of the lung. This syndrome of prostate cancer is rare and has been reported in only a few cases. We report a patient with ectopic ACTH production associated with metastatic prostate cancer. A 70-year-old patient with metastatic prostate cancer was admitted to our hospital with septic shock. He had a history of hormonal therapy and transurethral prostatectomy. Adrenocortical function was checked due to consistent fever and poor general condition, which revealed markedly increased levels of basal plasma ACTH and serum cortisol. The patient did not present typical signs of the Cushing's syndrome, however, hypokalemia and a history of hypertension were found. He died in days as a result of multi-organ failure. On pathology, the prostatectomy specimen showed a tumor composed of mixed populations of adenocarcinoma and small cell carcinoma. The tumor cells in the small cell component were positive for chromogranin and ACTH. Although neuroendocrine differentiation in prostate cancer is rare, etopic ACTH production should be considered in patients with prostate cancer as well as in clinical features of ACTH hypersecretion.

Keyword

Ectopic adrenocorticotropic hormone; Neuroendocrine tumors; Prostate cancer

MeSH Terms

ACTH Syndrome, Ectopic
Adenocarcinoma
Adrenocorticotropic Hormone
Aged
Carcinoma, Small Cell
Cellular Structures
Cushing Syndrome
Fever
Humans
Hydrocortisone
Hypertension
Hypokalemia
Lung
Neuroendocrine Tumors
Plasma
Prostate
Prostatectomy
Prostatic Neoplasms
Shock, Septic
Transurethral Resection of Prostate
Adrenocorticotropic Hormone
Hydrocortisone

Figure

• 

  Fig. 1 The progression of the prostate cancer. (A) Chest computed tomography (CT) taken 6 weeks ago showed pulmonary lymphangitic metastasis (arrows) with multiple metastatic mediastinal lymph nodes (circles), and (B) hepatic metastasis (arrows). (C) After 2 weeks, spine magnetic resonance imaging revealed epidural extension of T9 metastatic lesion with spinal cord compression, and (D) additional metastatic lesions in pancreas (circles) and both adrenal glands (arrows) were found in abdominal CT.

• 

  Fig. 2 Imaging studies at the emergency room. (A) Chest X-ray shows bilateral increased opacity. (B) Chest computed tomography reveals diffuse consolidation, ground-glass opacity and air-bronchogram at both lungs with increased size of mediastinal lymph nodes. Small amount of pleural effusion (bilateral) is shown. There was no evidence of pulmonary thromboembolism.

• 

  Fig. 3 Histologic and immunohistochemical features. (A) The tumor is composed of mixed populations of small cells (small cell carcinoma component) and glandforming clear cells (adenocarcinoma component) (H&E stain, × 200). (B) Chromogranin is expressed in the small cell carcinoma component, not in the adenocarcinoma component (immunohistochemistry, × 200). (C) In contrast, expression of prostate-specific antigen is confined to the adenocarcinoma component (immunohistochemistry, × 200). (D) A few tumor cells in small cell carcinoma component are reactive to adrenocorticotropic hormone (immunohistochemistry, × 400).

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