Endocrinol Metab > Volume 27(3); 2012 > Article
Endocrinology and Metabolism 2012;27(3):237-243.
DOI: https://doi.org/10.3803/EnM.2012.27.3.237    Published online September 19, 2012.
A Case of Ectopic ACTH Syndrome Associated with Metastatic Prostate Cancer.
Eun Ky Kim, Soo Heon Kwak, Hwa Young Ahn, Ah Reum Khang, Hyo Jin Park, So Yeon Park, Sang Eun Lee, Hak Chul Jang, Seong Yeon Kim, Young Joo Park
1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. yjparkmd@snu.ac.kr
2Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea.
3Department of Pathology, Seoul National University College of Medicine, Seoul, Korea.
4Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
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.
Key Words: Ectopic adrenocorticotropic hormone, Neuroendocrine tumors, Prostate cancer

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