Unusual Cushing's Syndrome and Hypercalcitoninaemia due to a Small Cell Prostate Carcinoma.

Antonio Balestrieri,Fiorella Nuzzo,Elena Magnani

doi:10.1155/2016/6308058

Antonio Balestrieri, Fiorella Nuzzo + Show 1 more

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https://doi.org/10.1155/2016/6308058

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Abstract

A 75-year-old man was hospitalized because of severe hypokalaemia due to ACTH dependent Cushing's syndrome. Total body computed tomography (TBCT) and 68 Gallium DOTATATE PET/CT localized a voluminous prostate tumour. A subsequent transurethral prostate biopsy documented a small cell carcinoma positive for ACTH and calcitonin and negative for prostatic specific antigen (PSA) at immunocytochemical study; serum prostatic specific antigen (PSA) was normal. Despite medical treatments, Cushing's syndrome was not controlled and the patient's clinical condition progressively worsened. Surgical resection was excluded; the patient underwent a cycle of chemotherapy followed by febrile neutropenia and fatal intestinal perforation. This case report describes a rare case of Cushing's syndrome and hypercalcitoninaemia due to a small cell carcinoma of the prostate, a rare tumour with very few therapeutic options and negative prognosis.

Highlights

Ectopic Cushing’s syndrome (CS) due to adrenocorticotropic hormone (ACTH) secretion accounts for about 10–15% of all ACTH dependent CS
We describe a rare case of Cushing syndrome due to an aggressive small cell prostate carcinoma associated with high levels of plasma calcitonin, an aggressive tumour with very few therapeutic options and a negative prognosis
Many nuclear medicine imaging modalities like F-FDGPET, octreoscan, or MIBG scintigraphy can be used in order to detect a neuroendocrine tumour, but it has been proven that 68 Gallium-somatostatin receptors (SSTR)-PET/CT, when available, can show the highest sensitivity in localizing ectopic ACTH secreting tumours, specially in occult diseases [15]

Summary

Introduction

Ectopic Cushing’s syndrome (CS) due to adrenocorticotropic hormone (ACTH) secretion accounts for about 10–15% of all ACTH dependent CS. Ectopic ACTH syndrome is frequently related to small cell carcinomas of the lung or neuroendocrine tumours such as bronchial carcinoids, thymic carcinoids, and pancreatic NETs; more rarely, other neuroendocrine tumours involving gastrointestinal and genitourinary tracts, pheochromocytomas, or medullary thyroid carcinomas may be involved [1, 2]. Plasma calcitonin is a marker of medullary thyroid carcinoma, generally useless in other clinical settings even if sometimes hypercalcitoninaemia can be associated with nonthyroid pathologies or other neuroendocrine tumours [3, 4]. We describe a rare case of Cushing syndrome due to an aggressive small cell prostate carcinoma associated with high levels of plasma calcitonin, an aggressive tumour with very few therapeutic options and a negative prognosis

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