Cushing's storm secondary to a rare case of ectopic ACTH secreting metastatic breast cancer

Endocrinology, Diabetes & Metabolism Case Reports

article

Maura Bucciarelli¹  Ya-Yu Lee²  Vasudev Magaji² 

[1] Department of Medicine, Lehigh Valley Health Network;Division of Endocrinology, Lehigh Valley Health Network

关键词: Adult;    Female;    White;    United States;    Adrenal;    Endocrine-related cancer;    Paediatric endocrinology;    Pituitary;    ACTH;    Cushing's syndrome;    Ectopic Cushing syndrome;    Breast cancer;    Metastatic carcinoma;    Posterior reversible encephalopathy syndrome;    Bilateral adrenal hyperplasia;    Psychosis;    Hypertension;    Paranoia;    Hirsutism;    Acne;    Impulsivity;    Inattention;    Blood pressure;    CT scan;    Liver biopsy;    Cortisol;    free (24-hour urine);    ACTH;    Testosterone;    DHEA Sulphate;    Cortisol;    Potassium;    Dexamethasone suppression;    17OHP;    Chemotherapy;    Etomidate;    Metyrapone;    Spironolactone;    Carboplatin;    Denosumab;    Gemcitabine;    Tamoxifen;    Neurology;    Insight into disease pathogenesis or mechanism of therapy;    October;    2015;   

DOI  :  10.1530/EDM-15-0051

学科分类：血液学

来源: Bioscientifica Ltd.

【 摘 要 】

Ectopic ACTH secretion from breast cancer is extremely rare. We report a case of a 30-year-old woman with a history of breastcancer, who presented with psychosis and paranoid behaviour. CT of the head showed white matter disease consistent withposterior reversible encephalopathy syndrome (PRES). Despite using mifepristone with multiple antihypertensives includinglisinopril, spironolactone and metoprolol, she was hypertensive. Transaminitis did not allow mifepristone dose escalation andketoconazole utilization. Etomidate infusion at a non-sedating dose in the intensive care unit controlled her hypertension andcortisol levels. She was transitioned to metyrapone and spironolactone. She was discharged from the hospital on metyraponewith spironolactone and underwent chemotherapy. She died 9 months later after she rapidly redeveloped Cushing’s syndromeand had progressive metastatic breast cancer involving multiple bones, liver and lungs causing respiratory failure.

【 授权许可】

CC BY-NC-ND