Ectopic Adrenocorticotropic Hormone-Producing Metastatic Gastrinoma: A Case Report.
capecitabine and temozolomide
ectopic cushing syndrome
gastrinoma
ketoconazole
metastatic gastrinoma
pancreatic neuroendocrine tumor
somatostatin analogs
Journal
Cureus
ISSN: 2168-8184
Titre abrégé: Cureus
Pays: United States
ID NLM: 101596737
Informations de publication
Date de publication:
Sep 2023
Sep 2023
Historique:
accepted:
15
09
2023
medline:
18
10
2023
pubmed:
18
10
2023
entrez:
18
10
2023
Statut:
epublish
Résumé
Pancreatic neuroendocrine tumors secreting gastrin and adrenocorticotropic hormone (ACTH) are rare. The presentation of the cases can be varied, making the diagnosis challenging and often delayed. Here, we present a patient who presented with severe hypokalemia and was found to have ectopic Cushing's syndrome. An abdominal CT scan showed a pancreatic lesion with metastatic liver disease. A biopsy of the liver lesion confirmed a metastatic neuroendocrine tumor. The final diagnosis was ectopic ACTH-producing metastatic gastrinoma. Twenty-four-hour urinary cortisol was significantly elevated at 9,790 mcg/24 hours. The excess hormonal secretion was successfully treated with ketoconazole and somatostatin analogs. She was further started on chemotherapy with capecitabine plus temozolomide, which has become the preferred chemotherapy treatment after the results of the recently completed trial. She also received Y90 therapy for metastatic liver disease. The prognosis of metastatic pancreatic neuroendocrine tumors is poor. Multidisciplinary combined therapies can help control disease and improve prognosis. We present an 18-month-long patient follow-up and a literature review of ectopic ACTH-producing metastatic gastrinomas.
Identifiants
pubmed: 37849614
doi: 10.7759/cureus.45329
pmc: PMC10577390
doi:
Types de publication
Case Reports
Langues
eng
Pagination
e45329Informations de copyright
Copyright © 2023, Tamhane et al.
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
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