Paraneoplastic Syndrome Secondary to Treatment Emergent Neuroendocrine Tumor in Metastatic Castration-resistant Prostate Cancer: A Unique Case

Murphy, Neal; Shen, Janice; Shih, Andrew; Liew, Anthony; Khalili, Houman; Yaskiv, Oksana; Katona, Kyle; Lee, Annette; Zhu, Xinhua

doi:10.1016/j.clgc.2018.09.002

Cited by 6 publications

(14 citation statements)

References 33 publications

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“…Less than 30 cases of SCPC associated with CS have previously been reported and were summarized by Elston et al (10) in 2017. Since then, Murphy et al (11) described an additional case of a 63-year-old male with EAS with a history of prostate adenocarcinoma, who was treated with radiation, androgen deprivation therapy, and later developed metastatic disease with neuroendocrine prostate cancer verified by biopsy.…”

Section: Discussionmentioning

confidence: 99%

“…While rare, prostate cancer variants including adenocarcinomas, small cell, and neuroendocrine prostate carcinomas can cause paraneoplastic syndromes and ectopic ACTH secretion (4)(5)(6)(7)(8)(9)(10)(11)(12). Recent studies suggest that the neuroendocrine differentiation of prostate cancer is associated with radiation and androgen deprivation therapy and correlates with poor prognosis (13).…”

Section: Introductionmentioning

confidence: 99%

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Ectopic Adrenocorticotropic Hormone Syndrome Due to Metastatic Prostate Cancer With Neuroendocrine Differentiation

Soundarrajan

Zelada

Fischer

et al. 2019

AACE Clinical Case Reports

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Objective: Neuroendocrine differentiation of prostate cancer can result in ectopic adrenocorticotropic hormone (ACTH) secretion (EAS) and Cushing syndrome. The aim of this report is to highlight this unusual mechanism of hypercortisolism and its management. Methods: We report a 73-year-old patient with a history of prostate adenocarcinoma who presented with severe weakness, hyperglycemia, and hypokalemia caused by EAS. Results: Diagnostic workup showed elevated 24-hour urine cortisol and ACTH levels consistent with EAS. Fluorodeoxyglucose positron emission tomographycomputed tomography revealed a hypermetabolic mass in the prostate and metastatic lesions to the liver and bones. Liver biopsy was consistent with small cell carcinoma with positive immunostaining for ACTH. Pleural fluid analysis was consistent with high-grade neuroendocrine carcinoma. The patient underwent chemotherapy with carboplatin and etoposide. Hypercortisolism was treated with ketoconazole, metyrapone, mifepristone, and spironolactone. He suffered complications including opportunistic infections, deep venous thrombosis, and delirium. Given his poor prognosis and clinical decline, the patient opted for comfort measures only in a hospice facility. Conclusion: Treatment-related neuroendocrine differentiation of prostate cancer is an emerging entity that may be associated with paraneoplastic syndromes including EAS. (AACE Clinical Case Rep. 2019;5:e192-e196) Abbreviations: ACTH = adrenocorticotropic hormone; CS = Cushing syndrome; CT = computed tomography; EAS = ectopic adrenocorticotrophic hormone syndrome; FDG = fluorodeoxyglucose; SCPC = small cell prostate carcinoma

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ectopic Adrenocorticotropic Hormone Syndrome Due to Metastatic Prostate Cancer With Neuroendocrine Differentiation

Soundarrajan

Zelada

Fischer

et al. 2019

AACE Clinical Case Reports

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“…Only 17% of cases have an elevated PSA as seen in our patient, which can mislead the diagnosis to prostate adenocarcinoma. We presented a case of SCC NEPC with ACTH-dependent CS as one presenting manifestation [6,11].…”

Section: Discussionmentioning

confidence: 99%

“…The 2016 World Health Organization classification consensus distinguishes adenocarcinoma with neuroendocrine differentiation from well-differentiated neuroendocrine tumors and high-grade neuroendocrine tumors that include small cell neuroendocrine carcinoma (SCC) and large cell neuroendocrine carcinoma [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

“…Paraneoplastic manifestations -symptoms related to the production of bioactive substances from cancer cells, or occasionally related to immune cross-reactivity to cancer neo-antigens -can occur at any stage [6,7]. Paraneoplastic Cushing's syndrome (CS) accounts for 10%-20% of CS and develops secondary to neoplastic adrenocorticotropic hormone (ACTH) production, leading to hypercortisolism and its wide range of clinical manifestations including increased mortality.…”

Section: Introductionmentioning

confidence: 99%

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Cushing Syndrome as a Manifestation of Neuroendocrine Prostate Cancer: A Rare Presentation Within a Rare Tumor

Fernandes¹,

Santos²,

Reis³

et al. 2021

Cureus

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Neuroendocrine prostate cancer (NEPC) is a rare entity representing 1% of all prostate malignancies, associated with poor prognosis and often concomitant with paraneoplastic syndromes such as Cushing's syndrome (CS) with ectopic adrenocorticotropic hormone (ACTH) production.We present a case of a 56-year-old man with recent lower urinary tract symptoms hospitalized for pelvic pain, rectal tenesmus, and fatigue. A CT scan documented a large prostatic mass, adenomegalies, and hepatic lesions. Bone scintigraphy showed dispersed osteoblastic metastization. The patient had uncontrolled hypertension and hypokalemia that lead to the diagnosis of paraneoplastic ACTH-dependent CS. Prostate biopsy confirmed small cell NEPC. Potassium supplementation, anti-hypertensive medication, and metyrapone were initiated. The patient was proposed for palliative chemotherapy but died within a few days from a urinary tract infection.The authors aim to draw attention to a case of paraneoplastic CS, a rare manifestation, within the rarity that is NEPC.

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Abiraterone acetate/antiandrogens

2019

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Paraneoplastic Syndrome Secondary to Treatment Emergent Neuroendocrine Tumor in Metastatic Castration-resistant Prostate Cancer: A Unique Case

Cited by 6 publications

References 33 publications

Ectopic Adrenocorticotropic Hormone Syndrome Due to Metastatic Prostate Cancer With Neuroendocrine Differentiation

Ectopic Adrenocorticotropic Hormone Syndrome Due to Metastatic Prostate Cancer With Neuroendocrine Differentiation

Cushing Syndrome as a Manifestation of Neuroendocrine Prostate Cancer: A Rare Presentation Within a Rare Tumor

Abiraterone acetate/antiandrogens

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