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      Unusual Cushing's Syndrome and Hypercalcitoninaemia due to a Small Cell Prostate Carcinoma

      case-report

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          Abstract

          A 75-year-old man was hospitalized because of severe hypokalaemia due to ACTH dependent Cushing's syndrome. Total body computed tomography (TBCT) and 68 Gallium DOTATATE PET/CT localized a voluminous prostate tumour. A subsequent transurethral prostate biopsy documented a small cell carcinoma positive for ACTH and calcitonin and negative for prostatic specific antigen (PSA) at immunocytochemical study; serum prostatic specific antigen (PSA) was normal. Despite medical treatments, Cushing's syndrome was not controlled and the patient's clinical condition progressively worsened. Surgical resection was excluded; the patient underwent a cycle of chemotherapy followed by febrile neutropenia and fatal intestinal perforation. This case report describes a rare case of Cushing's syndrome and hypercalcitoninaemia due to a small cell carcinoma of the prostate, a rare tumour with very few therapeutic options and negative prognosis.

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          The value of (68)Ga-DOTATATE PET/CT in diagnosis and management of neuroendocrine tumors compared to current FDA approved imaging modalities: a review of literature.

          Alireza Mojtahedi, Sanjay I. Thamake, Izabela Tworowska … (2014)
          Neuroendocrine tumors (NETs) are rare group of neoplasms arising from nervous and endocrine systems. Somatostatin analogue imaging is a functional imaging modality of choice for evaluating the NETs. Recent availability of positron emitting radioisotope labeled somatostatin analogues to image neuroendocrine cancers, has raised the interests to use this new imaging modality in management of patients with NETs. (68)Ga-DOTATATE PET/CT has demonstrated superiority in lesion detection compared to Octreoscan, MIBG scintigraphy and MRI. In this article, we reviewed the published studies evaluating the role of (68)Ga-DOTATATE PET in diagnosis and management of patients with neuroendocrine tumors and comparing it to current FDA approved imaging modalities including Octreoscan, MIBG scintigraphy, (18)F FDG PET/CT, CT and MRI.
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            Hypercalcitoninemia is not Pathognomonic of Medullary Thyroid Carcinoma

            Sergio PA Toledo, Delmar M. Lourenço, Marcelo Finazzi-Santos … (2009)
            Hypercalcitoninemia has frequently been reported as a marker for medullary thyroid carcinoma. Currently, calcitonin measurements are mostly useful in the evaluation of tumor size and progression, and as an index of biochemical improvement of medullary thyroid carcinomas. Although measurement of calcitonin is a highly sensitive method for the detection of medullary thyroid carcinoma, it presents a low specificity for this tumor. Several physiologic and pathologic conditions other than medullary thyroid carcinoma have been associated with increased levels of calcitonin. Several cases of thyroid nodules associated with increased values of calcitonin are not medullary thyroid carcinomas, but rather are related to other conditions, such as hypercalcemias, hypergastrinemias, neuroendocrine tumors, renal insufficiency, papillary and follicular thyroid carcinomas, and goiter. Furthermore, prolonged treatment with omeprazole (> 2–4 months), beta-blockers, glucocorticoids and potential secretagogues, have been associated with hypercalcitoninemia. An association between calcitonin levels and chronic auto-immune thyroiditis remains controversial. Patients with calcitonin levels >100 pg/mL have a high risk for medullary thyroid carcinoma (~90%–100%), whereas patients with values from 10 to 100 pg/mL (normal values: <8.5 pg/mL for men, < 5.0 pg/mL for women; immunochemiluminometric assay) have a <25% risk for medullary thyroid carcinoma. In multiple endocrine neoplasia type 2 (MEN2), RET mutation analysis is the gold-standard for the recommendation of total preventive thyroidectomy to relatives at risk of harboring a germline RET mutation (50%). False-positive calcitonin results within MEN2 families have led to incorrect indications of preventive total thyroidectomy to RET mutation negative relatives. In this review, we focus on the differential diagnosis of hypercalcitoninemia, underlining its importance for the avoidance of misdiagnosis of medullary thyroid carcinoma and consequent incorrect recommendation for thyroid surgery.
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              Conventional and Nuclear Medicine Imaging in Ectopic Cushing's Syndrome: A Systematic Review.

              Andrea Isidori, Emilia Sbardella, Maria Chiara Zatelli … (2015)
              Ectopic Cushing's Syndrome (ECS) can be a diagnostic challenge with the hormonal source difficult to find. This study analyzes the accuracy of imaging studies in ECS localization.
              Article 0 comments Cited 41 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Case Rep Endocrinol
                Journal ID (iso-abbrev): Case Rep Endocrinol
                Journal ID (publisher-id): CRIE
                Title: Case Reports in Endocrinology
                Publisher: Hindawi Publishing Corporation
                ISSN (Print): 2090-6501
                ISSN (Electronic): 2090-651X
                Publication date (Print): 2016
                Publication date (Electronic): 1 December 2016
                Volume: 2016
                Electronic Location Identifier: 6308058
                Affiliations
                1Endocrinology and Diabetology Unit, “M. Bufalini” Hospital, ASL of Romagna, Cesena, Italy
                2Internal Medicine Unit, “M. Bufalini” Hospital, ASL of Romagna, Cesena, Italy
                3Pathology Unit, “M. Bufalini” Hospital, ASL of Romagna, Cesena, Italy
                Author notes

                Academic Editor: Michael P. Kane

                Author information
                http://orcid.org/0000-0001-8620-1900
                Article
                DOI: 10.1155/2016/6308058
                PMC ID: 5156792
                PubMed ID: 28044110
                SO-VID: 422dc7cf-e7ce-4c8f-8880-17f62ee50223
                Copyright © Copyright © 2016 Antonio Balestrieri et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 6 June 2016
                Date revision received : 5 October 2016
                Date accepted : 23 October 2016
                Categories
                Subject: Case Report

                Data availability:

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