Bucciarelli Maura, Lee Ya-Yu, Magaji Vasudev
Department of Medicine , Lehigh Valley Health Network , Allentown, Pennsylvania, 18103 , USA.
Division of Endocrinology, Department of Medicine , Lehigh Valley Health Network , Allentown, Pennsylvania, 18103 , USA.
Endocrinol Diabetes Metab Case Rep. 2015;2015:150051. doi: 10.1530/EDM-15-0051. Epub 2015 Sep 2.
Ectopic ACTH secretion from breast cancer is extremely rare. We report a case of a 30-year-old woman with a history of breast cancer, who presented with psychosis and paranoid behaviour. CT of the head showed white matter disease consistent with posterior reversible encephalopathy syndrome (PRES). Despite using mifepristone with multiple antihypertensives including lisinopril, spironolactone and metoprolol, she was hypertensive. Transaminitis did not allow mifepristone dose escalation and ketoconazole utilization. Etomidate infusion at a non-sedating dose in the intensive care unit controlled her hypertension and cortisol levels. She was transitioned to metyrapone and spironolactone. She was discharged from the hospital on metyrapone with spironolactone and underwent chemotherapy. She died 9 months later after she rapidly redeveloped Cushing's syndrome and had progressive metastatic breast cancer involving multiple bones, liver and lungs causing respiratory failure.
Cushing's syndrome from ectopic ACTH secreting breast cancer is extremely rare.Cushing's syndrome causing psychosis could be multifactorial including hypercortisolism and PRES.Etomidate at non-sedating doses in intensive care setting can be effective to reduce cortisol production followed by transition to oral metyrapone.
乳腺癌异位分泌促肾上腺皮质激素极为罕见。我们报告一例30岁有乳腺癌病史的女性，她出现了精神病和偏执行为。头部CT显示白质病变，符合后部可逆性脑病综合征（PRES）。尽管使用了米非司酮及多种抗高血压药物，包括赖诺普利、螺内酯和美托洛尔，但她仍患有高血压。转氨酶升高不允许增加米非司酮剂量及使用酮康唑。在重症监护病房以非镇静剂量输注依托咪酯控制了她的高血压和皮质醇水平。她转而使用甲吡酮和螺内酯。她出院时服用甲吡酮和螺内酯，并接受了化疗。9个月后，她因迅速复发库欣综合征且患有进展性转移性乳腺癌，累及多骨、肝脏和肺部导致呼吸衰竭而死亡。
异位分泌促肾上腺皮质激素的乳腺癌导致的库欣综合征极为罕见。库欣综合征导致精神病可能是多因素的，包括皮质醇增多症和PRES。在重症监护环境中，非镇静剂量的依托咪酯可有效减少皮质醇生成，随后过渡到口服甲吡酮。
