Sacerdote Alan, Inoue Taiga, Thomas Nithin, Bahtiyar Gul
Department of Medicine, Woodhull Medical Mental Health Center, Brooklyn, New York, USA.
Department of Medicine, Coney Island Hospital, Brooklyn, New York, USA.
BMJ Case Rep. 2015 Dec 23;2015:bcr2015211520. doi: 10.1136/bcr-2015-211520.
Cortisol production by hepatocellular carcinoma (HCC) has not been previously reported and dehydroepiandrosterone (DHEA) secretion by HCC is rare. We report a case of a 53-year-old woman admitted with dyspnoea and headache. Serum cortisol by immunoassay (IA) was 42.3 μg/dL, urine free cortisol (UFC) by liquid chromatography mass spectrometry (LC/MS/MS) was 106.1 μg/24 h, serum DHEA by LC/MS/MS was 4886 ng/mL, serum DHEA-S by LC/MS/MS was 4477 ng/mL and plasma adrenocorticotrophic hormone (ACTH) by IA was 10 pg/mL. CT showed likely HCC metastatic to the left adrenal gland, brain and lungs. Liver and adrenal gland biopsies confirmed HCC. ACTH tumour staining was negative. High serum and UFC levels and high serum DHEA and DHEA-S with low-normal plasma ACTH and negative tumour ACTH staining suggested ACTH-independent ectopic Cushing's syndrome (CS); cortisol and DHEA being likely secreted by the HCC. To the best of our knowledge, this is the first reported case of HCC associated with CS.
肝细胞癌（HCC）产生皮质醇的情况此前未见报道，且HCC分泌脱氢表雄酮（DHEA）的情况较为罕见。我们报告一例53岁女性患者，因呼吸困难和头痛入院。免疫分析法（IA）检测血清皮质醇为42.3μg/dL，液相色谱-质谱联用（LC/MS/MS）检测尿游离皮质醇（UFC）为106.1μg/24小时，LC/MS/MS检测血清DHEA为4886ng/mL，LC/MS/MS检测血清硫酸脱氢表雄酮（DHEA-S）为4477ng/mL，IA检测血浆促肾上腺皮质激素（ACTH）为10pg/mL。CT显示可能为转移至左肾上腺、脑和肺的HCC。肝脏和肾上腺活检确诊为HCC。ACTH肿瘤染色为阴性。高血清和UFC水平以及高血清DHEA和DHEA-S水平，同时血浆ACTH处于低正常水平且肿瘤ACTH染色为阴性，提示为非ACTH依赖性异位库欣综合征（CS）；皮质醇和DHEA可能由HCC分泌。据我们所知，这是首例报道的与CS相关的HCC病例。
