Ectopic ACTH Production Caused by Metastatic Parotid Gland Acinic Cell Carcinoma

• Published in: AACE clinical case reports 2021-01, Vol.7 (1), p.32-35
• Main Authors: Burch, Jacob M., Choi, James S., Mosalem, Osama, Charles, Lawrenshey
• Format: Article
• Language: English
• Subjects: acinic cell carcinoma; Case Report; Cushing's disease; ectopic ACTH; paraneoplastic
• ISSN: 2376-0605; 2376-0605
• DOI: 10.1016/j.aace.2020.11.006

To present a case of adrenocorticotropic hormone (ACTH) hypersecretion caused by a metastatic acinic cell carcinoma (AcCC) of the parotid. Only 6 cases have been reported prior to October 2019. We believe that this condition is under-reported and hope that improved recognition will improve its reporting. Diagnosis in this case was done using surgical pathology of the primary tumor, involving lymph nodes, and a metastatic lesion. Following an initial misdiagnosis, a final diagnosis of AcCC was made using immunohistochemical staining. ACTH hypersecretion was diagnosed by testing for random ACTH, cortisol, and 24-hour urine aldosterone and cortisol levels. A 57-year-old man presented with hypokalemia, lower-extremity edema, and left-side rib pain 7 months following excision of a 4-cm left-parotid tumor. Immunostaining positive for DOG-1, CK7, pan-cytokeratin (including CAM5.2), and SOX10 led to the diagnosis of AcCC. ACTH hypersecretion was diagnosed based on a random ACTH level of 307 pg/mL (normal morning value, 7.2-63 pg/mL), a cortisol level of 33 μg/dL (normal morning value, 4.3-19.8 μg/dL; normal PM value, 3.1-15.0 μg/dL), a 24-hour urine aldosterone level of