Paraneoplastic Syndromes (Endocrine Syndromes)
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Hypercalcemia of Malignancy: Hypercalcemia with cancer is classified as humoral Hypercalcemia of malignancy (HHM), which is caused by circulating hormones, or local osteolytic Hypercalcemia (LOH), which is caused by local paracrine factors secreted by cancers within bone.
Parathyroid hormone-related peptide (PTHrP) causes nearly all cases of HHM, while the mediators of LOH in bone are heterogeneous. Hypercalcemia of malignancy is treated by:
- Hydration with saline
- Forced diuresis
- Bisphosphonates: etridonate, pamidronate, zolendronate
This condition is usually seen in Head and Neck Cancers especially Squamous Cell cancers , Lung Cancers, Some Lymphomas.
Hyponatremia of Malignancy: due to the inappropriate secretion of arginine vasopressin (AVP) and is termed the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Small cell lung cancer is the malignancy chiefly responsible for producing ectopic AVP
Oncogenic Osteomalacia: Associated with Hemangiopericytomas as well as infrequently with fibromas and sarcomas.
Ectopic Acth Syndrome responsible for ~15% of all cases of Cushing’s syndrome and for most cases of Cushing’s syndrome that occur in cancer patients .
Ectopic ACTH syndrome is most commonly due to small cell lung cancer (50% of cases), bronchial carcinoid tumors (10%), thymic carcinoid tumors or thymomas (10%), pancreatic islet cell tumors (10%), pheochromocytoma or other neural crest tumors (5%), or medullary carcinoma of the thyroid (5%).
Ectopic Acromegaly: Ectopic production of growth hormone-releasing hormone (GHRH) is the predominant cause of ectopic acromegaly
The cancers associated with ectopic acromegaly include carcinoid tumors of the bronchus, pancreatic islet cell tumors, and cancers of the lung, breast, colon, and adrenal glands.
Gynecomastia Ectopic production of hCG is the most common cause of paraneoplastic gynecomastia; hepatoma or a germ cell tumor with choriocarcinoma elements contains aromatase enzyme activity that converts circulating androgens to estrogen.
Other tumors rarely associated with ectopic gynecomastia include carcinoid tumors of the bronchus, intestine, and small cell lung cancer.About 5% of men with testicular choriocarcinoma present with an enlarging breast mass
Hypertension: JG Cell tumours especially Renal, Lungs, Pancreas and sometimes ovarian Tumours
Paraneoplastic Pemphigus: Pemphigus is a disease of skin and mucosae. Associated with blistering of skin especially in Lymphomas and Castelmans Tumour
Non-islet Cell Tumor Hypoglycemia can occur with large, slow-growing sarcomas, mesotheliomas, and hepatomas.
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