Rickman T, Garmany R, Doherty T, Benson D, Okusa M D
Department of Medicine, University of Virginia Health Systems, Charlottesville, VA 22901, USA.
Am J Kidney Dis. 2001 Apr;37(4):838-46. doi: 10.1016/s0272-6386(01)80134-7.
Ectopic adrenocorticotropic hormone (ACTH) and/or corticotropin-releasing hormone (CRH) are associated with a growing list of tumors. We report a 69-year-old white man with a history of high-grade prostate carcinoma and widely metastatic adenocarcinoma who presented with metabolic alkalosis, hypokalemia, and hypertension secondary to ectopic ACTH and CRH secretion. Laboratory values were consistent with hypokalemia and metabolic alkalosis. Markedly elevated serum cortisol (135 microg/dL), ACTH (1,387 pg/dL), CRH (69 pg/dL), and urine free cortisol (16,276 microg/24 h) levels were found. Chest computed tomographic (CT) scan showed small noncalcified parenchymal densities; however, bronchoscopy and bronchoalveolar lavage washings were unremarkable for a neoplastic process. Abdominal CT scan and magnetic resonance imaging showed multiple small liver lesions and multiple thoracic and lumbar intensities consistent with diffuse metastatic disease. Histological analysis of a biopsy specimen from the thoracic spine showed an undifferentiated adenocarcinoma consistent with a prostate primary tumor. The severe metabolic alkalosis secondary to glucocorticoid-induced excessive mineralocorticoid activity was treated with potassium supplements, spironolactone, and ketoconazole. In this case report, we describe an unusual tumor associated with ectopic ACTH and CRH production and the pharmacodynamic relationship of plasma cortisol levels and urinary cortisol excretion with ketoconazole treatment.
异位促肾上腺皮质激素（ACTH）和/或促肾上腺皮质激素释放激素（CRH）与越来越多的肿瘤相关。我们报告了一名69岁的白人男性，有高级别前列腺癌和广泛转移性腺癌病史，因异位ACTH和CRH分泌继发代谢性碱中毒、低钾血症和高血压。实验室检查结果与低钾血症和代谢性碱中毒一致。发现血清皮质醇（135μg/dL）、ACTH（1387pg/dL）、CRH（69pg/dL）和尿游离皮质醇（16276μg/24小时）水平显著升高。胸部计算机断层扫描（CT）显示小的非钙化实质密度影；然而，支气管镜检查和支气管肺泡灌洗对肿瘤过程无明显异常发现。腹部CT扫描和磁共振成像显示多个小的肝脏病变以及多个与弥漫性转移疾病一致的胸腰椎强化影。胸椎活检标本的组织学分析显示为未分化腺癌，与前列腺原发性肿瘤一致。继发于糖皮质激素诱导的过度盐皮质激素活性的严重代谢性碱中毒，通过补充钾、螺内酯和酮康唑进行治疗。在本病例报告中，我们描述了一种与异位ACTH和CRH产生相关的不寻常肿瘤，以及酮康唑治疗时血浆皮质醇水平和尿皮质醇排泄的药效学关系。
