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Hajjar SL, Magacha HM, Notta SN, Joseph D. Non-metastatic Nephrogenic Hepatic Dysfunction (Stauffer Syndrome) and Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) in a Patient With Renal Cell Carcinoma Coinciding With Liposarcoma. Cureus 2024; 16:e55714. [PMID: 38586650 PMCID: PMC10998433 DOI: 10.7759/cureus.55714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/09/2024] Open
Abstract
Stauffer syndrome is a non-metastatic, nephrogenic, hepatic dysfunction syndrome that is linked to extrahepatic paraneoplastic tumors. It manifests with varying clinical signs that include jaundice, anicteric transaminitis, elevated alkaline phosphatase, thrombocytosis, elevated erythrocyte sedimentation rate, prolonged prothrombin time, and, in some cases, hepatosplenomegaly in the absence of hepatobiliary obstruction. Stauffer syndrome is mostly associated with renal cell carcinoma, but research shows other solid malignancies are implicated with this syndrome. Stauffer syndrome is characterized by elevated liver function tests, specifically those that indicate the presence of cholestasis with or without hepatosplenomegaly. The abnormality is not due to tumor infiltration but rather indirect paraneoplastic effects that are poorly understood. Additionally, emerging literature also supports the association of syndrome of inappropriate antidiuretic hormone secretion (SIADH) secondary to malignancy in the setting of elevated interleukin-6. In this article, we present the case of a 76-year-old patient with SIADH and abnormalities in liver function tests in the context of Stauffer syndrome tied to renal cell carcinoma coinciding with liposarcoma.
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Affiliation(s)
- Sabahuddin L Hajjar
- Internal Medicine, East Tennessee State University James H. Quillen College of Medicine, Johnson City, USA
| | - Hezborn M Magacha
- Internal Medicine, East Tennessee State University, Johnson City, USA
| | - Shahnawaz N Notta
- Internal Medicine, East Tennessee State University James H. Quillen College of Medicine, Johnson City, USA
| | - David Joseph
- Nephrology, Veterans Affairs Medical Center, Mountain Home, Johnson City, USA
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Ryś M, Piotrowicz K, Chłosta M, Ostachowski M, Gryglewska B, Chłosta P, Gąsowski J. Mild elevation of liver function tests associated with renal cell carcinoma in a multimorbid older patient - a case of Stauffer's syndrome. Cent European J Urol 2023; 76:190-192. [PMID: 38045781 PMCID: PMC10690386 DOI: 10.5173/ceju.2023.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/01/2023] [Accepted: 06/16/2023] [Indexed: 12/05/2023] Open
Abstract
We describe a case of a 74-year-old patient with recurrent fever of up-to 38.5°C, nocturnal sweating, weight loss of 4 kg, non-characteristic pain, and elevation of liver function tests (LFTs), who was diagnosed with Stauffer's syndrome. The patient successfully underwent laparoscopic heminephrectomy. The histology was clear-cell carcinoma of the right kidney (cT1a). The abnormalities in laboratory tests, such as Erythrocyte Sedimentation Rate, C-reactive protein, LFTs, α2-globulin, and most clinical symptoms abated 2 weeks post-surgery. We hypothesize that elevated LFTs in renal cell carcinoma patients could help deciding in favour of surgery in cases where the initial decision would be watchful waiting.
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Affiliation(s)
- Monika Ryś
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
| | - Karolina Piotrowicz
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
| | - Marcin Chłosta
- Department of Urology, Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz Ostachowski
- Department of Urology, Jagiellonian University Medical College, Kraków, Poland
| | - Barbara Gryglewska
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
| | - Piotr Chłosta
- Department of Urology, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy Gąsowski
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
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Khanal S, Bhatt T, Atogwe ID, Itare V, Shrestha E, Sulh M. Stauffer Syndrome as the Initial Presentation of Advanced Metastatic Prostate Cancer. Cureus 2023; 15:e37663. [PMID: 37200673 PMCID: PMC10188316 DOI: 10.7759/cureus.37663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2023] [Indexed: 05/20/2023] Open
Abstract
Stauffer's syndrome is a paraneoplastic syndrome that has historically been associated with renal cell carcinoma. It is defined by the anicteric elevation of liver enzymes in the absence of liver metastasis, and the reversibility of clinical and biochemical changes upon treatment of the primary pathology. Here, we discuss the rare presentation of Stauffer's syndrome in a patient with advanced metastatic prostate cancer. A 72-year-old male presented with generalized weakness, dizziness, weight loss, and icterus who was incidentally found to have a prostatic enlargement on physical examination. The laboratory investigations and radiographic imaging confirmed the diagnosis of metastatic prostatic cancer without any evidence of mechanical biliary obstruction as confirmed by biopsy and imaging. The cancer had metastasized to pelvic sidewalls, pelvic bones, ribs, urinary bladder, and local lymph nodes. Our case signifies that a high index of suspicion for underlying cancer should be maintained in patients presenting with cholestatic liver dysfunction, with or without jaundice, especially in the absence of a recognizable mechanical etiology of cholestasis.
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Affiliation(s)
- Sneha Khanal
- Internal Medicine, BronxCare Health System, Bronx, USA
| | | | | | - Vikram Itare
- Internal Medicine, BronxCare Health System, Bronx, USA
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Popov DR, Antonov KA, Atanasova EG, Pentchev CP, Milatchkov LM, Petkova MD, Neykov KG, Nikolov RK. Renal cell carcinoma presented with a rare case of icteric Stauffer syndrome: A case report. World J Clin Cases 2022; 10:9087-9095. [PMID: 36157651 PMCID: PMC9477025 DOI: 10.12998/wjcc.v10.i25.9087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 06/16/2022] [Accepted: 07/31/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Paraneoplastic syndromes remain poorly understood and manifest as multifaceted clinical symptoms, making their diagnosis difficult. Cholestasis can be observed in various malignancies. In rare cases, it can be a paraneoplastic manifestation, most often associated with renal cell carcinoma and other urogenital tumors, as well as with bronchial carcinoma. The classical form of Stauffer syndrome presents with a reversible anicteric increase of cholestatic liver function tests, thrombocytosis, coagulation impairment, and hepatosplenomegaly, without any proven hepatobiliary obstruction or metastases.
CASE SUMMARY We report a patient who presented with elevated liver enzymes, cholestatic jaundice, weight loss and pruritus, in whom renal cell carcinoma was incidentally found during hospitalization. Clinical, laboratory, and imaging tests excluded primary hepatic cause or metastatic disease. Jaundice and laboratory abnormalities reversed completely a few months after nephrectomy. This case is an example of the many sides of renal cell carcinoma, and it focuses the clinicians’ attention on the differential diagnosis of cholestasis, including Stauffer syndrome and its variant. Thus, the correct diagnosis can be straightforward and the associated malignancy can be treated promptly. All cases should be followed up with a multidisciplinary team. Interleukin (IL)-6 is proposed to contribute to the pathophysiology of the condition. The probable mechanism is proinflammatory activity by the IL-6 cytokine, causing elevation of C-reactive protein and haptoglobin and inhibition of hepatobiliary transporter gene expression, impairing biliary outflow.
CONCLUSION Despite being rare, Stauffer syndrome is a potentially reversible paraneoplastic condition, when the primary cause is treatable. This syndrome should be considered by clinicians because of the remediable liver disturbance, after successful treatment of the underlying malignancy.
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Affiliation(s)
- Dimitar R Popov
- Medical University of Sofia, Sofia 1431, Bulgaria
- Clinic of Gastroenterology, University Hospital ’St. Ivan Rilski’, Sofia 1431, Bulgaria
| | - Krasimir A Antonov
- Medical University of Sofia, Sofia 1431, Bulgaria
- Clinic of Gastroenterology, University Hospital ’St. Ivan Rilski’, Sofia 1431, Bulgaria
| | - Evelina G Atanasova
- Clinic of Gastroenterology, University Hospital ’St. Ivan Rilski’, Sofia 1431, Bulgaria
| | - Christo P Pentchev
- Medical University of Sofia, Sofia 1431, Bulgaria
- Clinic of Gastroenterology, University Hospital ’St. Ivan Rilski’, Sofia 1431, Bulgaria
| | - Lyuben M Milatchkov
- Clinic of Gastroenterology, University Hospital ’St. Ivan Rilski’, Sofia 1431, Bulgaria
| | - Maria D Petkova
- Medical University of Sofia, Sofia 1431, Bulgaria
- Clinic of Gastroenterology, University Hospital ’St. Ivan Rilski’, Sofia 1431, Bulgaria
| | | | - Rosen K Nikolov
- Medical University of Sofia, Sofia 1431, Bulgaria
- Clinic of Gastroenterology, University Hospital ’St. Ivan Rilski’, Sofia 1431, Bulgaria
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Kim YH, Park JM, Kang CD, Seo SO, Lee K, Song G. Prostate Cancer Presenting with Pruritus and Cholestasis. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2021; 78:59-64. [PMID: 34312359 DOI: 10.4166/kjg.2021.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 11/03/2022]
Abstract
Jaundice is a rare symptom of the paraneoplastic syndrome associated with prostate cancer. We report a case of metastatic prostate cancer that presented as jaundice. There was an absence of biliary obstruction and hepatic metastasis; therefore, the paraneoplastic syndrome was suggested as the etiology of cholestasis. Jaundice improved with the treatment of prostate cancer. In the literature, interleukin-6 has been suggested to be associated with paraneoplastic syndrome.
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Affiliation(s)
- Young Hee Kim
- Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jin Myung Park
- Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Chang Don Kang
- Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Sang Oh Seo
- Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Kyougyul Lee
- Department of Anatomic Pathology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Geehyun Song
- Department of Urology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
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Ishiyama Y, Kondo T, Tachibana H, Ishihara H, Fukuda H, Yoshida K, Takagi T, Iizuka J, Tanabe K. Predictive role of γ-glutamyltransferase in patients receiving nivolumab therapy for metastatic renal cell carcinoma. Int J Clin Oncol 2020; 26:552-561. [PMID: 33135126 DOI: 10.1007/s10147-020-01819-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 10/18/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION γ-Glutamyltransferase is reportedly associated with survival in local and metastatic renal cell carcinoma patients; however, its predictive role among patients treated with immune-checkpoint inhibitors are unknown. This study aimed to investigate the role of γ-glutamyltransferase as a predictive marker among metastatic renal cell carcinoma patients undergoing nivolumab therapy. METHODS We retrospectively evaluated 69 nivolumab-treated metastatic renal cell carcinoma patients upon failure of one or more systematic therapies. Serum γ-glutamyltransferase levels were determined at baseline and 2 months after nivolumab treatment initiation. Patients were classified as high (≥ 49 U/L) and low (< 49 mg/dL) from baseline GGT levels and the outcomes were compared between the two groups. Furthermore, increased (after/baseline ≥ 2) and non-increased (after/baseline < 2) groups were compared. Progression-free survival and overall survival were evaluated after nivolumab initiation. RESULTS Overall survival was significantly shorter in the high baseline γ-glutamyltransferase group (20.3%) than in the low group (79.7%) (median 2.33 vs not reached [months], p = 0.0051). Progression-free survival and the overall survival were significantly shorter in the increased than in the non-increased group (24.6% and 75.4%, respectively) (median PFS: 4.43 vs 7.23 [months], p = 0.0373/OS: 24.00 vs not reached, p = 0.0467). On multivariate analyses, high baseline γ-glutamyltransferase was an independent factor for overall survival (p = 0.0345) and increased γ-glutamyltransferase was an independent factor for progression-free survival (p = 0.0276) and overall survival (p = 0.0160). CONCLUSIONS High baseline γ-glutamyltransferase and its early increase are associated with a poor prognosis in metastatic renal cell carcinoma patients receiving nivolumab. Serum γ-glutamyltransferase levels may help predict treatment outcomes.
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Affiliation(s)
- Yudai Ishiyama
- Department of Urology, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan.,Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan.
| | - Hidekazu Tachibana
- Department of Urology, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan
| | - Hiroki Ishihara
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Hironori Fukuda
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Kazuhiko Yoshida
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Junpei Iizuka
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan
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Tanous B, Alsaud A, Mahmoud KE, Yassin MA. A Rare Presentation of Stauffer's Syndrome Associated with Renal Cell Carcinoma. Case Rep Oncol 2020; 13:742-746. [PMID: 32774269 PMCID: PMC7383159 DOI: 10.1159/000508039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 04/20/2020] [Indexed: 01/20/2023] Open
Abstract
Renal cell carcinoma (RCC) is a primary tumor of the kidneys. It is characterized by the triad of flank pain, hematuria, and a palpable flank mass. However, most RCC patients present with a paraneoplastic manifestation of the disease. Stauffer's syndrome (a non-metastatic hepatic dysfunction) is a rare paraneoplastic manifestation associated with RCC. We report the case of a 30-year-old male, obese, who presented with hematuria and was found to have a right renal mass secondary to RCC. During his hospital stay, the patient developed acute hepatic dysfunction that resolved rapidly after tumor resection.
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Affiliation(s)
- Bashar Tanous
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Arwa Alsaud
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Mohamed A Yassin
- Department of Medical Oncology, Hamad Medical Corporation, Doha, Qatar
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Chavarriaga J, Fakih N, Cataño J, Villaquiran C, Rodriguez S, Patino G. Stauffer syndrome, clinical implications and knowledge gaps, does size matter? Case report. BMC Urol 2020; 20:105. [PMID: 32689980 PMCID: PMC7370459 DOI: 10.1186/s12894-020-00671-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/08/2020] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Stauffer Syndrome (SS) is a paraneoplastic disorder associated with renal cell carcinoma (RCC). First described by Herbert Maurice Stauffer in 1961, it is characterized by hepatic dysfunction in the absence of metastasis, and elevated alkaline phosphatase, aminotransferases and prolonged prothrombin time. Initial reports did not include jaundice as an inclusion criterion. We aim to report the rare SS jaundice variant in a patient with a small renal mass and review the literature to determine if the size of the renal mass could influence the development of the SS. CASE PRESENTATION The aim of this article is to present the case of a 53-year-old male with Stauffer syndrome jaundice variant secondary to a 2.5 cm renal mass, treated with laparoscopic radical nephrectomy with complete resolution of the syndrome. CONCLUSIONS This syndrome is yet to be fully understood, and as far as the evidence shows, size does not matter. This entity should always be in mind when encountered with a patient with liver dysfunction and jaundice with a suspicion or confirmed diagnosis of a renal mass. To date, and to our knowledge, there have been eleven reported cases of paraneoplastic cholestatic jaundice syndrome including the current case. Six cases presented in patients with small renal mases (< 4 cm), curiously there were not a laterality tendency.
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Affiliation(s)
- Julian Chavarriaga
- Division of Urologic Oncology, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Carrera 7 No. 40 - 62, Bogotá, Colombia, 11011.
| | - Nayib Fakih
- Division of Urologic Oncology, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Carrera 7 No. 40 - 62, Bogotá, Colombia, 11011
| | - Juan Cataño
- Division of Urologic Oncology, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Carrera 7 No. 40 - 62, Bogotá, Colombia, 11011
| | - Catalina Villaquiran
- Division of Urologic Oncology, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Carrera 7 No. 40 - 62, Bogotá, Colombia, 11011
| | - Santiago Rodriguez
- Division of Urologic Oncology, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Carrera 7 No. 40 - 62, Bogotá, Colombia, 11011
| | - German Patino
- Division of Urologic Oncology, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Carrera 7 No. 40 - 62, Bogotá, Colombia, 11011
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