title: Ectopic Cushing's syndrome due to concurrent corticotropin-releasing hormone (CRH) and adrenocorticotropic hormone (ACTH) secreted by malignant gastrinoma.
abstract: Ectopic Cushing's syndrome due to various malignancies is not uncommon. However, a few cases of ectopic Cushing's syndrome caused by corticotropin-releasing hormone (CRH), or CRH with adrenocorticotropic hormone (ACTH) have been reported. A 28-year-old woman presented with acute upper gastrointestinal bleeding caused by an active ulcer, located atypically in the 2nd portion of duodenum. Further work-up revealed high gastrin levels and abdominal computed tomography (CT) scans showed a large pancreatic head mass with multiple liver metastases. The serum cortisol and ACTH levels were checked due to hypokalemia with metabolic alkalosis and recent amenorrhea. Cortisol and ACTH were both highly elevated with pituitary hyperplasia and elevated CRH. The existence of ectopic ACTH and CRH in the liver biopsy was also demonstrated immunohistochemically. Since an operation was not feasible, chemotherapy was conducted using paclitaxel and etoposide. These two drugs were chosen according to the IN VITRO chemotherapy response assay to maximize the treatment. This report demonstrates concurrent ACTH- and CRH-related ectopic Cushing's syndrome caused by malignant gastrinoma with multiple liver metastases that was treated with marginal success using a multidisciplinary medical approach.
authors.affiliation: Department of Internal Medicine and Endocrine Research Institute, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: S Y
authors.initials: SY
authors.lastname: Park
authors.forename: Y
authors.initials: Y
authors.lastname: Rhee
authors.forename: J C
authors.initials: JC
authors.lastname: Youn
authors.forename: Y N
authors.initials: YN
authors.lastname: Park
authors.forename: S
authors.initials: S
authors.lastname: Lee
authors.forename: D M
authors.initials: DM
authors.lastname: Kim
authors.forename: S Y
authors.initials: SY
authors.lastname: Song
authors.forename: S-K
authors.initials: SK
authors.lastname: Lim
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood*; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D003346:Corticotropin-Releasing Hormone / Q000097:blood*; D003480:Cushing Syndrome / Q000097:blood* / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D004379:Duodenal Neoplasms / Q000188:drug therapy / Q000378:metabolism* / Q000473:pathology / Q000556:secondary; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D015408:Gastrinoma / Q000150:complications / Q000188:drug therapy / Q000378:metabolism* / Q000473:pathology; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008113:Liver Neoplasms / Q000188:drug therapy / Q000378:metabolism* / Q000473:pathology / Q000556:secondary; D017239:Paclitaxel / Q000008:administration & dosage; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000378:metabolism* / Q000473:pathology / Q000556:secondary
chemical_list: D005047:Etoposide; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D017239:Paclitaxel; D006854:Hydrocortisone