Response

We would like to thank Dr Quinton for his thoughtful and precise response to our case report. The possibility of our patient’s Cushing’s syndrome being secondary to CRH secretion is recognised and accepted. The dominant histology, however, of both the pelvic mass and metastatic lesions were of a small cell neuroendocrine tumour rather than adenocarcinoma. Prostate specific antigen level was normal, suggesting a quiescent adenocarcinoma component. When considering the possibility of CRH secretion, we reviewed the literature and found only one case of small cell cancer of the prostate releasing CRH, 1 as opposedCMJv19n1-Letters-ClinMed.indd 89 1/3/19 2:10 PM90 © Royal College of Physicians 2019. All rights reserved. Letters to the editor over a dozen examples of ACTH secreting small cell carcinoma, starting with Wenk et al in 1978. 2 Regrettably, the consent for our patient’s autopsy did not include examination of intracranial contents, so we were unable to examine the pituitary gland.