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Irina Bancos, M.D., an endocrinologist at Mayo Clinic in Rochester, Minnesota, and Jamie J. Van Gompel, M.D., a neurosurgeon at Mayo Clinic's campus in Minnesota, discuss Mayo's multidisciplinary approach to adrenocorticotropic hormone (ACTH)-secreting pituitary tumors. Pituitary tumors are common and often don't cause problems. But some pituitary tumors produce the hormone ACTH, which stimulates the production of another hormone (cortisol). Overproduction of cortisol can result in Cushing syndrome, with signs and symptoms such as weight gain, skin changes and fatigue. Cushing syndrome is rare but can cause significant long-term health problems. Treatment for Cushing syndrome caused by a pituitary tumor generally involves surgery to remove the tumor. Radiation therapy and occasionally adrenal surgery may be needed to treat Cushing syndrome caused by ACTH-secreting pituitary tumors. Mayo Clinic has experience with this rare condition.
A patient with depression developed Cushing’s syndrome (CS) because of a rare ACTH-secreting small cell cancer of the prostate, a case study reports. The case report, “An unusual cause of depression in an older man: Cushing’s syndrome resulting from metastatic small cell cancer of the prostate,” was published in the “Lesson of the Month” section of Clinical Medicine. Ectopic CS is a condition caused by an adrenocorticotropic hormone (ACTH)-secreting tumor outside the pituitary or adrenal glands. The excess ACTH then acts on the adrenal glands, causing them to produce too much cortisol. Small cell cancer is more common in older men, those in their 60s or 70s. Sources of ectopic ACTH synthesis arising in the pelvis are rare; nonetheless, ACTH overproduction has been linked to tumors in the gonads and genitourinary organs, including the prostate. Still, evidence suggests there are less than 30 published cases reporting ectopic CS caused by prostate cancer. Researchers from the Southern Adelaide Local Health Network and the Royal Adelaide Hospital in Australia described the case of an 84-year-old man who complained of fatigue, back pain, and lack of appetite. Blood tests revealed mildly elevated prostate-specific antigen (PSA) and creatinine levels, which could indicate the presence of prostate cancer and impaired kidney function, respectively. The patient had a history of locally invasive prostate cancer even though he didn’t experience any symptoms of this disease. Ultrasound examination showed an enlarged prostate plus obstructed ureters — the tubes that carry urine from the kidney to the bladder. To remove the obstruction, doctors inserted a thin tube into both ureters and restored urine flow. After the procedure, the man had low levels of calcium, a depressed mood, and back pain, all of which compromised his recovery. Imaging of his back showed no obvious reason for his complaints, and he was discharged. Eight days later, the patient went to the emergency room of a large public hospital because of back pain radiating to his left buttock. The man also had mild proximal weakness on both sides. He was thinner, and had low levels of calcium, high blood pressure and serum bicarbonate levels, plus elevated blood sugar. In addition, his depression was much worse. A psychiatrist prescribed him an antidepressant called mirtazapine, and regular follow-up showed that his mood did improve with therapy. A computed tomography (CT) scan revealed a 10.5 cm tumor on the prostate and metastasis on the lungs and liver. Further testing showed high serum cortisol and ACTH levels, consistent with a diagnosis of Cushing’s syndrome. But researchers could not identify the ACTH source, and three weeks later, the patient died of a generalized bacterial infection, despite treatment with broad-spectrum antibiotics. An autopsy revealed that the cancer had spread to the pelvic sidewalls and to one of the adrenal glands. Tissue analysis revealed that the patient had two types of cancer: acinar adenocarcinoma and small cell neuroendocrine carcinoma — which could explain the excess ACTH. Cause of death was bronchopneumonia, a severe inflammation of the lungs, triggered by an invasive fungal infection. Investigators believe there are things to be learned from this case, saying, “Neither the visceral metastases nor aggressive growth of the pelvic mass noted on imaging were typical of prostatic adenocarcinoma. [Plus], an incomplete diagnosis at death was the precipitant for a post-mortem examination. The autopsy findings were beneficial to the patient’s family and treating team. The case was discussed at a regular teaching meeting at a large tertiary hospital and, thus, was beneficial to a wide medical audience.” Although a rare cause of ectopic ACTH synthesis, small cell prostate cancer should be considered in men presenting with Cushing’s syndrome, especially in those with a “mystery” source of ACTH overproduction. “This case highlights the importance of multidisciplinary evaluation of clinical cases both [before and after death], and is a fine example of how autopsy findings can be used to benefit a wide audience,” the researchers concluded. https://cushingsdiseasenews.com/2018/10/16/rare-prostate-cancer-prostate-associated-cushings-syndrome-case-report/
Guest posted a question in Guest QuestionsHi Everyone! I am SO glad i found this website! I know in my heart that I have an endocrine disorder. I have recently switched to a whole new network of doctors hoping and praying this group will have help for me! So the past two years I had undergone an extreme amount of stress (loss of family member, parents divorcing, domestic abuse resolved, loss of child, loss of house, unexpected homelessness at 18, mother abandoning and relocating to another country after meeting a man online, mother having pulmonary embolism resulting with her and I finding out we both have multiple blood disorders etc etc etc) that coupled with starting a new birth control pill (which i heard raises cortisol levels). I am currently on zoloft only and have no alcohol, drug, or cigarette use ever. I am definitely MUCH better now having worked through this all in counseling/church finding great support!! But I thought I should give a back story of when it all started!! My symptoms: Rapid Weight Gain (95 lbs in one year with normal healthy diet) AND despite constant diet and exercising w/ trainer, haven't lost a POUND! DRY skin including terrible dandruff, red bumps on arms and legs, peeling skin on face with red cheeks but pimples on chin even with layers of moisturizers and lotions! Brittle nails and hair SO dry!! Unusual hair growth (not much YET but its still growing) - around jaw, neck, chest, and stomach. BAD stretch marks on stomach, arms, breast, chest, back, legs, knees, etc... To the point of looking like I was pregnant with triplets! They were dark purple, now turning white/yellow. Chronic Fatigue Chronic Muscle Pain everywhere worse in pelvic area, lower back, neck, shoulders. Short of breath but low blood pressure. Swelling of ankles and feet. Legs and arms skinny but belly and back huge! No buffalo hump on neck, though. Legs and arms frequently go numb. Constant nausea. Irregular bowel movements Frequent and urgent urination Depression/Anxiety (a lot more well managed now than before zoloft was having terrible panic attacks) Severe Hot Flashes And all of a sudden I'll get back and chest pain and have hot flashes but blood pressure still normal. Severe abdominal swelling with no cause, then goes back to normal in a few days. AND MORE! It's to the point where I had to quit my job and can't work thus leaving me unfortunately relying on fiance. I want to be my healthy self again! I was a model and competed in triathlons!! I have seen: Primary Care Neurologist Oncologist Hematologist Gynecologist/Obstetrician Cardiologist Nutritionist Personal Trainer Allergist Physical Therapist Rheumatologist Gastroenterologist None of them have been any help, trying every test in the book with everything negative. Had thyroid checked twice two years ago when all started and was normal. Also had CT scan, MRI, Xrays, POTS testing, Blood Tests, Urine Samples, Upper and Lower GI, Barium Swallow, Physical Endurance Testing, Etc etc etc etc I can't even remember the rest hahaha! And JUST TODAY my new OB/GYN suggested I try and see an endocrinologist... FINALLY! Someone who may know what she's talking about. I have NEW HOPE! Any advice or insight at all would be SO greatfully appreciated. THANK YOU SO MUCH!!!!