title: Treatment-related neuroendocrine prostate cancer resulting in Cushing's syndrome.
abstract: Here we present, to the best of our knowledge, the first case of a paraneoplastic Cushing's syndrome (hypercortisolism) resulting from treatment-related neuroendocrine prostate cancer - a highly aggressive and difficult disease to treat. A 51-year-old man was started on androgen deprivation therapy after presenting with metastatic prostate cancer, characterized by diffuse osseous metastasis. Shortly thereafter, he developed progressive disease with biopsy proven neuroendocrine prostate cancer as well as symptoms of increased skin pigmentation, hypokalemia, hypertension, hyperglycemia and profound weakness, consistent with ectopic Cushing's syndrome. Molecular analysis of the patient's tumor through RNA sequencing showed high expression of several genes including CHGA, ASCL1, CALCA, HES6, PCSK1, CALCB and INSM1 confirming his neuroendocrine phenotype; elevated POMC expression was found, supporting the diagnosis of ectopic Cushing's syndrome.
authors.affiliation: Department of Medicine, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Sundhar
authors.initials: S
authors.lastname: Ramalingam
authors.affiliation: Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Adva
authors.initials: A
authors.lastname: Eisenberg
authors.affiliation: Department of Medicine, Pathology Division, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Wen Chi
authors.initials: WC
authors.lastname: Foo
authors.affiliation: Department of Medicine, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Freedman
authors.affiliation: Department of Medicine, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Armstrong
authors.affiliation: Department of Medicine, Endocrinology Metabolism and Nutrition, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Larry G
authors.initials: LG
authors.lastname: Moss
authors.affiliation: Department of Medicine, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Harrison
mesh_terms: D003480:Cushing Syndrome / Q000209:etiology*; D015870:Gene Expression; D006801:Humans; D006943:Hyperglycemia; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary; D010257:Paraneoplastic Syndromes; D011471:Prostatic Neoplasms / Q000188:drug therapy*
keywords: Cushing's syndrome; castration-resistant; neuroendocrine transdifferentiation; paraneoplastic syndrome; prostate cancer