Chapter 096. Paraneoplastic Syndromes: Endocrinologic/Hematologic (Part 2)

Ectopic hormone production would only be an epiphenomenon associated with cancer if it did not result in clinical manifestations. Excessive and unregulated production of hormones such as ACTH, PTHrP, or vasopressin can lead to substantial morbidity and can complicate the cancer treatment plan. Moreover, the paraneoplastic endocrinopathies are sometimes the presenting feature of underlying malignancy and may prompt the search for an unrecognized tumor.A large number of paraneoplastic endocrine syndromes have been described, linking overproduction of particular hormones with specific types of tumors. However, certain recurring syndromes emerge from this group (Table 961). The most common paraneoplastic endocrine syndromes...
Nội dung trích xuất từ tài liệu:
Chapter 096. Paraneoplastic Syndromes: Endocrinologic/Hematologic (Part 2) Chapter 096. Paraneoplastic Syndromes: Endocrinologic/Hematologic (Part 2) Ectopic hormone production would only be an epiphenomenon associatedwith cancer if it did not result in clinical manifestations. Excessive andunregulated production of hormones such as ACTH, PTHrP, or vasopressin canlead to substantial morbidity and can complicate the cancer treatment plan.Moreover, the paraneoplastic endocrinopathies are sometimes the presentingfeature of underlying malignancy and may prompt the search for an unrecognizedtumor. A large number of paraneoplastic endocrine syndromes have beendescribed, linking overproduction of particular hormones with specific types oftumors. However, certain recurring syndromes emerge from this group (Table 96-1). The most common paraneoplastic endocrine syndromes include hypercalcemiafrom overproduction of PTHrP and other factors, hyponatremia from excessvasopressin, and Cushings syndrome from ectopic ACTH. Table 96-1 Paraneoplastic Syndromes Caused by Ectopic HormoneProduction Paraneoplastic Ectopic Hormone Typical TumorSyndrome Typesa Common Hypercalcemia Parathyroid Squamous cell (headof malignancy hormone-related protein and neck, lung, skin), breast, (PTHrP) genitourinary, gastrointestinal 1,25 Lymphomas dihydroxyvitamin D Parathyroid Lung, ovary hormone (PTH) (rare) Prostaglandin E2 Renal, lung (PGE2) (rare) Syndrome of Vasopressin Lung (squamous, smallinappropriate cell), gastrointestinal,antidiuretic hormone genitourinary, ovarysecretion (SIADH) Cushings Adrenocorticotropic Lung (small cell,syndrome hormone (ACTH) bronchial carcinoid, adenocarcinoma, squamous), thymus, pancreatic islet, medullary thyroid carcinoma Corticotropin- Pancreatic islet, releasing hormone (CRH) carcinoid, lung, prostate (rare) Ectopic expression Macronodular adrenal of gastric inhibitory hyperplasia peptide (GIP), luteinizing hormone (LH)/ human chorionic gonadotropin (hCG), other G protein– coupled receptors (rare) Less Common Non-islet cell Insulin-like growth Mesenchymal tumors,hypoglycemia factor (IGF-II) sarcomas, adrenal, hepatic, gastrointestinal, kidney, prostate Insulin (rare) Cervix (small cell carcinoma) Male hCGb Testis (embryonal,feminization seminomas), germinomas, choriocarcinoma, lung, hepatic, pancreatic islet Diarrhea or Calcitoninc Lung, colon, breast,intestinal hypermotility medullary thyroid carcinoma Vasoactive Pancreas, intestinal peptide (VIP) pheochromocytoma, esophagus Rare Oncogenic Phosphatonin Hemangiopericytomas,osteomalacia [fibroblast growth factor osteoblastomas, fibromas, 23 (FGF23)] sarcomas, giant cell tumors, pros ...