Treatment-related neuroendocrine prostate cancer resulting in Cushing's syndrome

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.

International journal of urology : official journal of the Japanese Urological Association. 2016 Oct 21 [Epub ahead of print]

Sundhar Ramalingam, Adva Eisenberg, Wen Chi Foo, Jennifer Freedman, Andrew J Armstrong, Larry G Moss, Michael R Harrison

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., Department of Medicine, Pathology Division, Duke University Medical Center, Durham, North Carolina, USA., Department of Medicine, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA., Department of Medicine, Endocrinology Metabolism and Nutrition, Duke University Medical Center, Durham, North Carolina, USA.