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						Practical Urology: EssEntial PrinciPlEs and PracticE
	Nonmetastatic Hepatic Dysfunction					first described a possible relationship between
	(Stauffer Syndrome)					RCC and Cushing’s syndrome.136 Subsequently,
	In 1961, Stauffer described hepatic abnormali-					RCC has been found to account for 2% of all
						neoplasms responsible for Cushing’s syndrome.
	ties in a patient with RCC with no evidence of					Galactorrhea and elevated serum prolactin lev-
	hepatic metastases. The abnormalities disap-					els have been described in two RCC cases.137
	peared after nephrectomy but returned with
	disease recurrence.126 The syndrome is charac-
	terized by elevations in liver enzymes as well as					Paraneoplastic Endocrine Syndromes
	abnormal levels of hepatic synthetic products.
						Associated with Other Urologic
	Elevations of aspartate aminotransferase, ala-
	nine aminotransferase, alkaline				phosphatase,	Malignances
	and prothrombine exist in 66% of cases.					Gynecomastia and ectopic production of human
	Additionally, elevated levels of gammaglobulin
	and bilirubin are seen in 54% and 27% of					chorionic gonadotropin (HCG) have been found
	patients with Stauffer’s syndrome, respec-					to be associated with transitional cell carcinoma
	tively.127,128 The cause of Stauffer’s syndrome is					of the bladder by a number of authors.138,139 It
	poorly understood. It has been hypothesized					has been reported that in patients with prostate
	that RCC itself can secrete hepatotoxins or lys-					carcinoma, small-cell de-differentiation of neo-
	osomal enzymes that stimulate hepatic cathep-					plastic cells are associated with Cushing’s
	sins or phosphatases leading to hepato-cellular					syndrome due to the ectopic production of
	injury.129,130 A second theory suggests that					ACTH.140
	tumor-secreted hepatotoxins lead to hepato-
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