title: Symptomatic Cushing's syndrome and hyperandrogenemia in a steroid cell ovarian neoplasm: a case report.
abstract: BACKGROUND
  Malignant steroid cell tumors of the ovary are rare and frequently associated with hormonal abnormalities. There are no guidelines on how to treat rapidly progressive Cushing's syndrome, a medical emergency.
  
  
  METHODS
  A 67-year-old white woman presented to our hospital with rapidly developing signs and symptoms of Cushing's syndrome secondary to a steroid-secreting tumor. Her physical and biochemical manifestations of Cushing's syndrome progressed, and she was not amenable to undergoing conventional chemotherapy secondary to the debilitating effects of high cortisol. Her rapidly progressive Cushing's syndrome ultimately led to her death, despite aggressive medical management with spironolactone, ketoconazole, mitotane, and mifepristone.
  
  
  CONCLUSIONS
  We report an unusual and rare case of Cushing's syndrome secondary to a malignant steroid cell tumor of the ovary. The case is highlighted to discuss the complications of rapidly progressive Cushing's syndrome, an underreported and often unrecognized endocrine emergency, and the best available evidence for treatment.
authors.affiliation: Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. sedhomr@gmail.com.
authors.forename: Ramy
authors.initials: R
authors.lastname: Sedhom
authors.affiliation: Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
authors.forename: Sophia
authors.initials: S
authors.lastname: Hu
authors.affiliation: Division of Endocrinology, Metabolism & Nutrition, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
authors.forename: Anupam
authors.initials: A
authors.lastname: Ohri
authors.affiliation: Department of Pathology and Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
authors.forename: Dorian
authors.initials: D
authors.lastname: Infantino
authors.affiliation: Division of Endocrinology, Metabolism & Nutrition, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Lubitz
mesh_terms: D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage*; D003480:Cushing Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D018450:Disease Progression; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D017588:Hyperandrogenism / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D007654:Ketoconazole; D008939:Mitotane; D010051:Ovarian Neoplasms / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D017410:Practice Guidelines as Topic; D035583:Rare Diseases; D018312:Sex Cord-Gonadal Stromal Tumors / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D013148:Spironolactone
chemical_list: D018931:Antineoplastic Agents, Hormonal; D013148:Spironolactone; D008939:Mitotane; D007654:Ketoconazole
keywords: Cushing’s syndrome; Ectopic cortisol; Hyperandrogenemia; Steroid cell ovarian neoplasm