PDF(Pubmed)
Abstract：
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.
摘要：
库欣综合征（CS），由于异位促肾上腺皮质激素（ACTH）的产生，构成各种恶性肿瘤的常见副肿瘤表现，最常见的是小细胞肺癌。在文学中,有文献记载,异位CS与前列腺癌相关的病例不到50例.在本研究中,报道一例76岁男性患有去势抵抗性前列腺腺癌,过去4年接受恩杂鲁胺和促黄体生成素释放激素(LHRH)类似物治疗.患者出现下肢肌无力到急诊科就诊,缓血球和低钾血症。经过全面的诊断评估，确定了高皮质醇血症。低剂量和高剂量地塞米松攻击后无抑制，皮质醇24h排泄增加和正常的垂体磁共振成像导致异位CS的诊断。立即靶向治疗开始与肾上腺类固醇生成抑制剂，包括甲吡酮和酮康唑以及多西他赛和泼尼松龙的化疗。几天之内皮质醇水平显着下降，不再需要住院治疗。患者成功完成了三个周期的化疗；不幸的是，他在诊断为异位CS后三个月内死亡。在本研究中,我们回顾了所有现有的与前列腺癌相关的副肿瘤CS病例。本研究的目的是强调对该实体进行早期诊断和治疗的必要性，因为它可能具有非典型的临床发现，并可能演变成危及生命的状况。
