Kato David, Okwara Chinemerem, Moreland Christopher, Parker Allan
University of Texas Health Science Center, San Antonio, TX, USA.
J Investig Med High Impact Case Rep. 2014 Jun 24;2(2):2324709614539927. doi: 10.1177/2324709614539927. eCollection 2014 Apr-Jun.
Cholestasis is a general feature of intrahepatic or extrahepatic biliary obstruction by various mechanisms including cirrhosis, stricture, choledocholithiasis, hepatitis, and neoplasms. Neoplasms can directly impinge on the hepatobiliary tree resulting in bile stasis. Stauffer's syndrome is another variant of this neoplastic process that can cause cholestasis and liver enzyme elevation without any direct hepatobiliary obstruction, and is thus categorized as a paraneoplastic syndrome of unclear pathophysiology. We report a first case of metastatic prostate adenocarcinoma with features of Stauffer's syndrome that reversed completely on androgen deprivation therapy. This is in contrast to a previously reported case of Stauffer's syndrome due to metastatic prostate adenocarcinoma, which reversed partially to androgen deprivation therapy. Our case demonstrates the importance of early recognition of Stauffer's syndrome and underlying neoplasms in patients who present with cholestasis without clear evidence of intrahepatic or extrahepatic biliary obstruction, which may lead to early initiation of treatment.
胆汁淤积是肝内或肝外胆管梗阻的一个普遍特征，其机制包括肝硬化、狭窄、胆总管结石、肝炎和肿瘤等。肿瘤可直接压迫肝胆管树，导致胆汁淤积。斯陶弗综合征是这种肿瘤性过程的另一种变体，可在无任何直接肝胆管梗阻的情况下引起胆汁淤积和肝酶升高，因此被归类为一种病理生理学尚不清楚的副肿瘤综合征。我们报告了首例具有斯陶弗综合征特征的转移性前列腺腺癌病例，该病例在雄激素剥夺治疗后完全逆转。这与之前报道的一例因转移性前列腺腺癌导致的斯陶弗综合征病例形成对比，该病例在雄激素剥夺治疗后部分逆转。我们的病例表明，对于出现胆汁淤积但无明确肝内或肝外胆管梗阻证据的患者，早期识别斯陶弗综合征和潜在肿瘤非常重要，这可能有助于早期开始治疗。
