Small cell metastatic prostate cancer with ectopic adrenocorticotropic hormone hypersecretion: a case report

Montes, María Riaza; Calvo, Pablo Arredondo; Sánchez, José Antonio Gallego

doi:10.21037/apm-21-656

Cited by 3 publications

(4 citation statements)

References 3 publications

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“…Furthermore, 7 out of 11 patients with paraneoplastic CS had a previous history of prostate adenocarcinoma, for which they were treated with ADT before developing neuroendocrine differentiation and CS [ 10 , 16 , 17 , 18 , 19 , 20 , 21 ]. Small cell carcinoma was the predominant histological subtype, with one case having a large cell NEPC [ 14 , 15 , 19 , 20 , 21 , 22 , 23 ]. In addition, Prostate Specific Antigen (PSA) levels were high in patients who reported a previous history of prostate adenocarcinoma [ 10 , 16 , 18 , 20 , 21 ] but were normal in patients who developed prostate neuroendocrine cancer de novo [ 14 , 15 , 23 ].…”

Section: Resultsmentioning

confidence: 99%

“…Small cell carcinoma was the predominant histological subtype, with one case having a large cell NEPC [ 14 , 15 , 19 , 20 , 21 , 22 , 23 ]. In addition, Prostate Specific Antigen (PSA) levels were high in patients who reported a previous history of prostate adenocarcinoma [ 10 , 16 , 18 , 20 , 21 ] but were normal in patients who developed prostate neuroendocrine cancer de novo [ 14 , 15 , 23 ]. The management of paraneoplastic CS was mostly based on Ketoconazole, Metyrapone, Spironolactone, and Potassium supplementation, along with treating hyperglycemia and hypertension.…”

Section: Resultsmentioning

confidence: 99%

“…As demonstrated in Table 2 , we found that CS is the most frequently reported PNS associated with NEPC. Patients presented in a variety of ways, including fluid overload, hypokalemia, resistant hypertension, metabolic alkalosis, easy bruising, fatigue, and generalized weakness [ 10 , 14 , 15 , 16 , 17 , 18 , 20 , 21 , 22 , 23 ]. On physical examination, many of the reviewed cases [ 14 , 15 , 16 , 17 , 18 , 20 , 21 ] had proximal weakness and edema, although the classical features of CS are usually absent in malignancy [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…Consistent with their findings, our review identified infections and multiple organ failure as the primary causes leading to mortality. It is well established that patients with hypercortisolism are at increased risk of infections, and with these infections spreading and becoming more generalized, sepsis and multiple organ failure ensue [ 10 , 14 , 17 , 22 , 23 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

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Paraneoplastic Syndromes in Neuroendocrine Prostate Cancer: A Systematic Review

Abufaraj,

Ramadan,

Alkhatib

2024

Current Oncology

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Neuroendocrine prostate cancer (NEPC) is a rare subtype of prostate cancer (PCa) that usually results in poor clinical outcomes and may be accompanied by paraneoplastic syndromes (PNS). NEPC is becoming more frequent. It can initially manifest as PNS, complicating diagnosis. Therefore, we reviewed the literature on the different PNS associated with NEPC. We systematically reviewed English-language articles from January 2017 to September 2023, identifying 17 studies meeting PRISMA guidelines for NEPC and associated PNS. A total of 17 articles were included in the review. Among these, Cushing’s Syndrome (CS) due to ectopic Adrenocorticotropic hormone (ACTH) secretion was the most commonly reported PNS. Other PNS included syndrome of inappropriate Anti-Diuretic Hormone secretion (SIADH), Anti-Hu-mediated chronic intestinal pseudo-obstruction (CIPO), limbic encephalitis, Evans Syndrome, hypercalcemia, dermatomyositis, and polycythemia. Many patients had a history of prostate adenocarcinoma treated with androgen deprivation therapy (ADT) before neuroendocrine features developed. The mean age was 65.5 years, with a maximum survival of 9 months post-diagnosis. NEPC is becoming an increasingly more common subtype of PCa that can result in various PNS. This makes the diagnosis and treatment of NEPC challenging. Further research is crucial to understanding these syndromes and developing standardized, targeted treatments to improve patient survival.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Paraneoplastic Syndromes in Neuroendocrine Prostate Cancer: A Systematic Review

Abufaraj,

Ramadan,

Alkhatib

2024

Current Oncology

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Molecular predictors of metastasis in patients with prostate cancer

Lin

Zhuo

Zhang

et al. 2023

Expert Review of Molecular Diagnostics

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Ectopic Cushing syndrome in metastatic castration‑resistant prostate cancer: A case report and review of literature

Andrikopoulou,

Goga,

Stefanaki

et al. 2024

Oncol Lett

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Cushing's syndrome (CS), as a result of ectopic adrenocorticotropic hormone (ACTH) production, constitutes a common paraneoplastic manifestation of various malignancies, with the most common being small cell lung carcinoma. In the literature, fewer than fifty cases associating ectopic CS with prostate cancer have been documented. In the present study, the case of a 76-year old man suffering from castration-resistant prostate adenocarcinoma that had been treated with enzalutamide and luteinizing hormone-releasing hormone (LHRH) analogue for the last four years is presented. The patient presented to the emergency department with lower extremity muscle weakness, bradypsychia and hypokalemia. Following a thorough diagnostic evaluation, hypercortisolemia was identified. No suppression after low-and high-dose dexamethasone challenge, increased cortisol 24 h excretion and normal pituitary magnetic resonance imaging led to the diagnosis of ectopic CS. Immediate targeted therapy was initiated with adrenal steroidogenesis inhibitors, including metyrapone and ketoconazole along with chemotherapy with docetaxel and prednisolone. There was a remarkable decrease in cortisol levels within days and hospitalization was no longer required. The patient managed to complete three cycles of chemotherapy; unfortunately, he succumbed within three months of the diagnosis of ectopic CS. In the present study, all existing cases of paraneoplastic CS related to prostate cancer are reviewed. The aim of the current study was to highlight the need of early diagnosis and treatment of this entity as it may present with atypical clinical findings and potentially evolve to a life-threatening condition.

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Small cell metastatic prostate cancer with ectopic adrenocorticotropic hormone hypersecretion: a case report

Cited by 3 publications

References 3 publications

Paraneoplastic Syndromes in Neuroendocrine Prostate Cancer: A Systematic Review

Paraneoplastic Syndromes in Neuroendocrine Prostate Cancer: A Systematic Review

Molecular predictors of metastasis in patients with prostate cancer

Ectopic Cushing syndrome in metastatic castration‑resistant prostate cancer: A case report and review of literature

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