title: Possible ACTH-independent, cortisol-secreting and DHEA-secreting metastatic hepatocellular carcinoma causing Cushing's syndrome.
abstract: Cortisol production by hepatocellular carcinoma (HCC) has not been previously reported and dehydroepiandrosterone (DHEA) secretion by HCC is rare. We report a case of a 53-year-old woman admitted with dyspnoea and headache. Serum cortisol by immunoassay (IA) was 42.3 μg/dL, urine free cortisol (UFC) by liquid chromatography mass spectrometry (LC/MS/MS) was 106.1 μg/24 h, serum DHEA by LC/MS/MS was 4886 ng/mL, serum DHEA-S by LC/MS/MS was 4477 ng/mL and plasma adrenocorticotrophic hormone (ACTH) by IA was 10 pg/mL. CT showed likely HCC metastatic to the left adrenal gland, brain and lungs. Liver and adrenal gland biopsies confirmed HCC. ACTH tumour staining was negative. High serum and UFC levels and high serum DHEA and DHEA-S with low-normal plasma ACTH and negative tumour ACTH staining suggested ACTH-independent ectopic Cushing's syndrome (CS); cortisol and DHEA being likely secreted by the HCC. To the best of our knowledge, this is the first reported case of HCC associated with CS.
authors.affiliation: Department of Medicine, Woodhull Medical Mental Health Center, Brooklyn, New York, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Sacerdote
authors.affiliation: Department of Medicine, Woodhull Medical Mental Health Center, Brooklyn, New York, USA.
authors.forename: Taiga
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Department of Medicine, Coney Island Hospital, Brooklyn, New York, USA.
authors.forename: Nithin
authors.initials: N
authors.lastname: Thomas
authors.affiliation: Department of Medicine, Woodhull Medical Mental Health Center, Brooklyn, New York, USA.
authors.forename: Gul
authors.initials: G
authors.lastname: Bahtiyar
mesh_terms: D000182:ACTH Syndrome, Ectopic / Q000150:complications; D000310:Adrenal Gland Neoplasms / Q000378:metabolism / Q000556:secondary*; D000311:Adrenal Glands / Q000378:metabolism* / Q000473:pathology; D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D001706:Biopsy; D001932:Brain Neoplasms / Q000556:secondary; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000378:metabolism* / Q000473:pathology; D002853:Chromatography, Liquid; D003480:Cushing Syndrome / Q000097:blood / Q000209:etiology*; D003687:Dehydroepiandrosterone / Q000097:blood / Q000378:metabolism*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000378:metabolism*; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000150:complications* / Q000473:pathology; D008175:Lung Neoplasms / Q000556:secondary; D008875:Middle Aged; D053719:Tandem Mass Spectrometry
chemical_list: D003687:Dehydroepiandrosterone; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone