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

Abstract

Cushing's syndrome (CS), as a result of ectopic adrenocorticotropic hormone (ACTH) production, consti‑ tutes 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 depart‑ ment with lower extremity muscle weakness, bradypsychia and hypokalemia. Following a thorough diagnostic evalua‑ tion, hypercortisolemia was identified. No suppression after low‑ and high‑dose dexamethasone challenge, increased cortisol 24 h excretion and normal pituitary magnetic reso‑ nance 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