Ectopic adrenocorticotropic hormone (ACTH) syndrome is mostly associated with neuroendocrine tumors and small cell carcinoma of the lung. This syndrome of prostate cancer is rare and has been reported in only a few cases. We report a patient with ectopic ACTH production associated with metastatic prostate cancer. A 70-year-old patient with metastatic prostate cancer was admitted to our hospital with septic shock. He had a history of hormonal therapy and transurethral prostatectomy. Adrenocortical function was checked due to consistent fever and poor general condition, which revealed markedly increased levels of basal plasma ACTH and serum cortisol. The patient did not present typical signs of the Cushing's syndrome, however, hypokalemia and a history of hypertension were found. He died in days as a result of multi-organ failure. On pathology, the prostatectomy specimen showed a tumor composed of mixed populations of adenocarcinoma and small cell carcinoma. The tumor cells in the small cell component were positive for chromogranin and ACTH. Although neuroendocrine differentiation in prostate cancer is rare, etopic ACTH production should be considered in patients with prostate cancer as well as in clinical features of ACTH hypersecretion.
ACTH Syndrome, Ectopic ; Adenocarcinoma ; Adrenocorticotropic Hormone ; Aged ; Carcinoma, Small Cell ; Cellular Structures ; Cushing Syndrome ; Fever ; Humans ; Hydrocortisone ; Hypertension ; Hypokalemia ; Lung ; Neuroendocrine Tumors ; Plasma ; Prostate ; Prostatectomy ; Prostatic Neoplasms ; Shock, Septic ; Transurethral Resection of Prostate

Background: Benign hyperplasia prostate is a common disease in older men (over 60 years old). Transurethral resection of benign hyperplasia prostate is a method of improving symptoms with the best results, though with a high rate of complications, in which the most serious complication is transurethral prostatectomy syndrome (TURPS). Objective: The study aimed to describe clinical and para-clinical characteristics of TURPS and to define some risk factors of TURPS. Subject and methods: A descriptive, prospective study was conducted in 200 patients, who underwent TURPS, ASA I-II at the Anesthetic Emergency Department, Viet Duc Hospital from April 2007 to October 2007. To describe TURPS by observing clinical signs and serum sodium. The risks of TURPS were considered as prostate weight, operation time and amounts of used irritants. Results: The incidence of the TURPS was 7% of all resections. Clinical signs of the TURPS were nausea, vomiting, headaches, confusion and disorientation. TURPS was associated with hypotension (42.9%), bradycardia (35.7%), increased CVP (21.4%). The sodium concentration fell below normal in certain patients (64.3%). The amount of 3% Sorbitol (> 20 liters) was an independent risk factor of TURPS, but not the prostate weight or the operation time. Conclusions: The main signs of TURPS included central nervous symptoms (100%), circulatory and respiratory disorders (42.9%, 21.4%, respectively) and hyponatremia (64.3%). Sorbitol 3% > 20 liters was an independent risk factor of TURPS.
Transurethral Prostatectomy Syndrome ; benign hyperplasia prostate