Ramalingam Sundhar, Eisenberg Adva, Foo Wen Chi, Freedman Jennifer, Armstrong Andrew J, Moss Larry G, Harrison Michael R
Department of Medicine, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA.
Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina, USA.
Int J Urol. 2016 Dec;23(12):1038-1041. doi: 10.1111/iju.13225. Epub 2016 Oct 21.
Here we present, to the best of our knowledge, the first case of a paraneoplastic Cushing's syndrome (hypercortisolism) resulting from treatment-related neuroendocrine prostate cancer - a highly aggressive and difficult disease to treat. A 51-year-old man was started on androgen deprivation therapy after presenting with metastatic prostate cancer, characterized by diffuse osseous metastasis. Shortly thereafter, he developed progressive disease with biopsy proven neuroendocrine prostate cancer as well as symptoms of increased skin pigmentation, hypokalemia, hypertension, hyperglycemia and profound weakness, consistent with ectopic Cushing's syndrome. Molecular analysis of the patient's tumor through RNA sequencing showed high expression of several genes including CHGA, ASCL1, CALCA, HES6, PCSK1, CALCB and INSM1 confirming his neuroendocrine phenotype; elevated POMC expression was found, supporting the diagnosis of ectopic Cushing's syndrome.
据我们所知，在此我们呈现首例因治疗相关的神经内分泌前列腺癌引发的副肿瘤性库欣综合征（皮质醇增多症）——这是一种极具侵袭性且难以治疗的疾病。一名51岁男性在被诊断为转移性前列腺癌（以弥漫性骨转移为特征）后开始接受雄激素剥夺治疗。此后不久，他病情进展，活检证实为神经内分泌前列腺癌，同时出现皮肤色素沉着增加、低钾血症、高血压、高血糖和极度虚弱等症状，符合异位库欣综合征。通过RNA测序对患者肿瘤进行分子分析显示，包括CHGA、ASCL1、CALCA、HES6、PCSK1、CALCB和INSM1在内的多个基因高表达，证实了其神经内分泌表型；发现POMC表达升高，支持异位库欣综合征的诊断。
