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Adrenal insufficiency and stage D carcinoma of the prostate
1Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.
Abstract:
A patient with stage D prostatic cancer but in reasonably good general health was discovered to have adrenal failure and tumor destruction of the adrenal glands. Because prostatic cancer is common and compatible with prolonged survival, we surveyed other patients with stage D prostatic cancer. On initial screening with the cosyntropin test, we found that 5 of 14 patients failed to respond with an increase in serum cortisol of 10 micrograms/dL, suggesting an adrenal failure incidence of 36%. Retesting, however, indicated that probably all of these were false-positive results.
Insights
Stage D prostate cancer patients may show initial signs of adrenal failure. However, further testing suggests these initial results are likely false positives, indicating no significant adrenal insufficiency in this population.
Area of Science:
- Endocrinology
- Oncology
Background:
- Prostate cancer, particularly stage D, is a prevalent malignancy often compatible with long-term survival.
- Adrenal gland involvement can occur in advanced cancers.
Observation:
- A patient with stage D prostate cancer presented with adrenal failure due to tumor destruction.
- This prompted an investigation into adrenal function in other stage D prostate cancer patients.
Findings:
- Initial screening using the cosyntropin test suggested adrenal failure in 36% (5 of 14) of patients.
- Subsequent retesting indicated that these initial positive results were likely false positives.
Implications:
- The incidence of adrenal failure in stage D prostate cancer patients may be lower than initially suggested by screening tests.
- Careful interpretation and retesting are crucial when assessing adrenal function in cancer patients.