Ectopic ACTH Syndrome by Prostate Cancer; An Autopsy Case

Abstract BACKGROUND New onset resistant hypertension in a previously stable patient with chronic hypertension should lead to consideration of secondary causes. Electrolyte abnormalities are useful clues for identifying some common causes, especially mineralocorticoid excess. CASE PRESENTATION We report the case of a 69-year-old man who developed severe resistant hypertension despite the use of 6 antihypertensive medications, including diuretics. He had metabolic alkalosis and hypokalemia with suppressed plasma renin activity and serum aldosterone. Concurrently, he was diagnosed with small cell neuroendocrine carcinoma of the prostate gland, a rare form of prostate cancer. Despite absence of typical Cushingoid features, investigation confirmed the diagnosis of ectopic adrenocorticotropic hormone (ACTH) syndrome from neuroendocrine prostate cancer. Because of the severity of his hypercortisolism, he underwent urgent bilateral adrenalectomy for hormonal and symptomatic control. Blood pressure improved significantly and he was dismissed with a single antihypertensive agent. Unfortunately, the patient died from his cancer 1 month later. CONCLUSION Primary and secondary hyperaldosteronism are usually diagnosed based on measurements of aldosterone and plasma renin activity. However, if plasma renin activity and aldosterone are both low, rare causes of mineralocorticoid excess such as ectopic ACTH syndrome should be entertained.

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Adrenocortical Ultrastructure in Ectopic Acth Syndrome

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100091172 ◽

1976 ◽

Vol 34 ◽

pp. 238-239

Author(s):

K. Kovacs ◽

E. Horvath ◽

W. Singer

Keyword(s):

Adrenal Cortex ◽

Zona Glomerulosa ◽

Ectopic Acth Syndrome ◽

Pituitary Neoplasms ◽

Electron Microscopic ◽

Adrenocortical Cells ◽

Cell Hyperplasia ◽

Ectopic Acth ◽

Ectopic Acth Production ◽

Microscopic Findings

Secretion of ACTH by non-pituitary neoplasms is recognized with increasing frequency. While the clinical and biochemical changes associated with ectopic ACTH production have been extensively studied recently, relatively little attention was focused on the morphology of the adrenal cortex and, to our knowledge, the fine structure of the adrenocortical cells in cases of ectopic ACTH syndrome has not been described so far. We report here the electron microscopic findings in the adrenal cortex of a 50-year-old man with a pancreatic apudoma. The patient showed the characteristic clinical and biochemical features of ectopic ACTH syndrome and because of extensive hypercorticism, underwent bilateral adrenalectomy.By light microscopy, the adrenal cortices showed extensive compact cell hyperplasia and lipid depletion. The zona glomerulosa was present in small foci and, except for a few places, fasciculata cells were noted under the fibrous capsule.

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Electron Microscopic investigation of crooke’s change in the pituitaries of patients with hypercorticism

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100156225 ◽

1989 ◽

Vol 47 ◽

pp. 848-849

Author(s):

E. Horvath ◽

K. Kovacs ◽

L. Stefaneanu ◽

N. Losinski

Keyword(s):

Nucleolar Organizer ◽

Microscopic Investigation ◽

Electron Microscopic Investigation ◽

Ectopic Acth Syndrome ◽

Nucleolar Organizer Regions ◽

Electron Microscopic ◽

Human Pituitary ◽

Ectopic Acth ◽

Crooke’S Hyalinization

Human pituitary corticotropins have unique morphologic markers: bundles of type-1 filaments, measuring approximately 70 A in width and representing cytokeratin. The extreme ring-like accumulation of type-1 filaments, known as Crooke's hyalinization, signals functional suppression of the corticotropins and occurs in endogenous and exogenous glucocorticoid excess, caused by ACTH-secreting pituitary adenoma, glucocorticoid secreting adrenocortical tumor, ectopic ACTH-syndrome and administration of pharmacologic doses of glucocorticoids. Cells of autonomous corticotroph adenomas usually do not show Crooke's hyalin change. A minority of these tumors, however, retains sensitivity to the negative feed-back effect of elevated blood glucocorticoid levels and display typical Crooke’s change.In the present study pituitary corticotropins in various phases of Crooke's hyalinization were investigated in patients with glucocorticoid excess of various origin, applying histology, immunocytochemistry, count of argyrophilic nucleolar organizer regions (AgNOR), and transmission electron microscopy.

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Abstract #21: Ectopic ACTH Syndrome from Cervical Cancer

Endocrine Practice ◽

10.1016/s1530-891x(20)43869-8 ◽

2003 ◽

Vol 9 ◽

pp. 8

Author(s):

Kashif M. Munir ◽

Richard B. Horenstein

Keyword(s):

Cervical Cancer ◽

Ectopic Acth Syndrome ◽

Ectopic Acth

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Assessment of endocrine disorders of the hypothalamicpituitary axis by nuclear medicine techniques

Nuklearmedizin ◽

10.1055/s-0038-1625645 ◽

2002 ◽

Vol 41 (02) ◽

pp. 80-90 ◽

Cited By ~ 2

Author(s):

F. Jockenhövel ◽

P. Theissen ◽

M. Dietlein ◽

W. Krone ◽

H. Schicha ◽

...

Keyword(s):

Nuclear Medicine ◽

Pituitary Adenomas ◽

Dopamine D2 Receptor ◽

Somatostatin Receptor ◽

D2 Receptor ◽

Ectopic Acth Syndrome ◽

Endocrine Disorders ◽

Ectopic Acth ◽

Number Of Patients ◽

Hypothalamic Pituitary Axis

SummaryThe following article reviews nuclear medicine techniques which can be used for assessment of endocrine disorders of the hypothalamic-pituitary axis. For planar and SPECT imaging somatostatin-receptor- and dopamine- D2-receptor-scintigraphy are the most widely distributed techniques. These nuclear medicine techniques may be indicated in selected cases to answer differential diagnostic problems. They can be helpful to search for presence and localization of receptor positive tissue. Furthermore they can detect metastasis in the rare cases of a pituitary carcinoma. Scintigraphy with Gallium-67 is suitable for further diagnostic evaluation in suspected hypophysitis. Other SPECT radiopharmaca do not have relevant clinical significance. F-18-FDG as PET radiopharmacon is not ideal because obvious pituitary adenomas could not be visualized. Other PET radiopharmaca including C-11-methionine, C-11-tyrosine, F-18-fluoroethylspiperone, C-11-methylspiperone, and C-11-raclopride are available in specialized centers only. Overall indications for nuclear medicine in studies for the assessment of endocrine disorders of the hypothalamic-pituitary-axis are rare. Original studies often report only about a small number of patients. According to the authors’ opinion the relevance of nuclear medicine in studies of clinically important endocrinologic fields, e. g. localization of small ACTH-producing pituitary adenomas, tumor localization in ectopic ACTH syndrome, localization of recurrent pituitary tissue, assessment of small incidentalomas, can not be definitely given yet.

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