Periprostatic paraganglioma causing occult Cushing’s syndrome

Excerpt

A 25-year-old Caucasian male noticed the onset of poor concentration, depression, occasional paranoid feelings, loss of libido and insomnia. Over a 12-month period he gradually developed a Cushingoid appearance. At first examination he had low serum potassium 2.7 mmol/l (reference range, 3.8–5.5), an elevated midnight cortisol 2202 nmol/l (reference range, <50) and ACTH 34 pmol/l (reference range <10.2). High-dose dexamethasone suppression test and bilateral inferior petrosal sinus sampling with CRH stimulation were consistent with an ectopic Cushing syndrome (ECS) [1]. He started with metyrapone therapy. Ketoconazole was added several months later. Mean cortisol was maintained between 200 and 350 nmol/l, while ACTH level had increased on these medications, varying between 173 and 479 ng/l. …