Triple negative breast cancer with ACTH-dependent Cushings syndrome - case report

Introduction: Endocrine and metabolic paraneoplastic syndromes in the course of malignant tumors result from ectopic production of hormones or hormone precursors in tumor cells. Production of hormones by endocrine tumors is relatively frequent, while such production by adenocarcinoma cells is definitely rare. The study presents a case of triple-negative invasive breast cancer, with the 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 the cause of metabolic disorders was breast cancer. After proper preparation, the patient was qualified for surgery. Results: After the mastectomy, the patient’s metabolism stabilized. The patient underwent adjuvant chemotherapy and radiotherapy. Four 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 individualized oncological approach, precise diagnostic tests, and adequate preoperative preparation.