title: Ectopic Cushing's syndrome due to CRH secreting liver metastasis in a patient with medullary thyroid carcinoma.
abstract: Ectopic production of CRH by a medullary thyroid carcinoma or its metastases is a rare cause of ectopic Cushing's syndrome (ECS). We report a 45-year old male with medullary thyroid carcinoma (MTC), who, 24 years following the initial diagnosis, presented with clinical and biochemical evidence of an ACTH dependent Cushing's syndrome. Rapid deterioration of his clinical condition and elevated cortisol levels were observed. Computed tomographic imaging of the abdomen revealed extensive liver metastases. The patient underwent fine needle aspiration biopsy of a liver lesion and immunohistochemistry showed that the cells expressed calcitonin, carcino-embryonic antigen and synaptophysin. Further analysis revealed that the material also expressed CRH. This is an unusual case of a CRH-secreting liver metastasis from a medullary thyroid carcinoma 24 years after the initial diagnosis of MTC.
authors.affiliation: Unit of Endocrinology & Endocrine Oncology, Theagenio Cancer Hospital, Thessaloniki, Greece. alexri@otenet.gr
authors.forename: Alexandra
authors.initials: A
authors.lastname: Chrisoulidou
authors.forename: Kalliopi
authors.initials: K
authors.lastname: Pazaitou-Panayiotou
authors.forename: Eleni
authors.initials: E
authors.lastname: Georgiou
authors.forename: Maria
authors.initials: M
authors.lastname: Boudina
authors.forename: George
authors.initials: G
authors.lastname: Kontogeorgos
authors.forename: Ioannis
authors.initials: I
authors.lastname: Iakovou
authors.forename: Ioannis
authors.initials: I
authors.lastname: Efstratiou
authors.forename: Frideriki
authors.initials: F
authors.lastname: Patakiouta
authors.forename: Iraklis
authors.initials: I
authors.lastname: Vainas
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood; D044963:Biopsy, Fine-Needle; D018276:Carcinoma, Medullary / Q000150:complications* / Q000378:metabolism / Q000556:secondary; D003346:Corticotropin-Releasing Hormone / Q000378:metabolism*; D003480:Cushing Syndrome / Q000209:etiology* / Q000378:metabolism / Q000473:pathology; D017809:Fatal Outcome; D006729:Hormones, Ectopic / Q000378:metabolism*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007150:Immunohistochemistry; D008113:Liver Neoplasms / Q000150:complications* / Q000378:metabolism / Q000556:secondary; D008297:Male; D008875:Middle Aged; D013964:Thyroid Neoplasms / Q000378:metabolism / Q000473:pathology*; D016312:Treatment Refusal
chemical_list: D006729:Hormones, Ectopic; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone