Triple negative breast cancer with ACTH-dependent Cushing's syndrome - case report

Abstract

Introduction: Endocrine and metabolic paraneoplastic syndromes in the course of malignant tumours result from ectopic production of hormones or hormone precursors in tumour cells. Production of hormones by endocrine tumours is relatively frequent, while such production by adenocarcinoma cells is definitely rare. The study presents a case of triple negative invasive breast cancer, with ectopic secretion of ACTH (Adrenocorticotropic hormone), which provokes serious metabolic disorders. Materials and methods: The patient was admitted to hospital with symptoms of Cushing`s syndrome. Diagnostic tests revealed that a cause of metabolic disorders was breast cancer. After proper preparation the patient was qualified for surgery. Results: After mastectomy the patient’s metabolism stabilised. The patient underwent adjuvant chemotherapy and radiotheraphy. 4 months after the last cycle of systemic treatment, cancer dissemination was found. The patient was treated with second-line chemotherapy, however control CT revealed progression. The patient died 20 months after surgery and two months after the last cycle of chemotherapy. Conclusions: The case reported in this study – triple negative invasive breast cancer, responsible for ectopic production of ACTH and causing Cushing’s syndrome – is a rare phenomenon. Treatment of patients with breast cancer showing hormonal activity should not differ from general rules applied for breast cancer. However due to accompanying metabolic disturbances, the patients need individualised oncological approach, precise diagnostic tests and adequate preoperative preparation.