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Acute lymphoblastic leukemia with large molecular ACTH production.
M Makita1, Y Maeda, K Hashimoto
1Department of Biopathology Science, Graduate School of Medicine and Dentistry, Okayama University Graduate Schools, 2-5-1 Shikatacho, 700-8558 Okayama, Japan. makita@d5.dion.ne.jp
Annals of Hematology
|May 17, 2003
Summary
This study details a rare case of acute lymphoblastic leukemia (ALL) producing adrenocorticotropic hormone (ACTH). Leukemia cells were identified as the source of ectopic ACTH, resolving upon chemotherapy.
Area of Science:
- Hematology
- Endocrinology
- Oncology
Background:
- Ectopic hormone production is uncommon in hematological malignancies.
- This case highlights a rare instance of adrenocorticotropic hormone (ACTH) production in acute lymphoblastic leukemia (ALL).
Observation:
- A 47-year-old male presented with hyperpigmentation and markedly elevated plasma ACTH without circadian rhythm, alongside normal cortisol levels.
- Bone marrow examination confirmed ALL, with no other identifiable cause for elevated ACTH.
- Plasma ACTH analysis revealed both authentic ACTH and a larger molecular form, likely proopiomelanocortin.
Findings:
- The discrepancy between elevated ACTH and normal cortisol was attributed to ectopic ACTH with low biological activity.
- Successful remission induction chemotherapy led to the disappearance of leukemia cells, normalization of ACTH levels, and improvement in hyperpigmentation.
Implications:
- This case suggests that leukemia cells can produce ACTH in certain hematological malignancies.
- It underscores the importance of considering ectopic hormone production in complex oncological cases.
- The findings contribute to understanding the diverse clinical manifestations of ALL.