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Paraneoplastic syndromes (DOC)

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					Bronchogenic carcinoma can be associated with a number of paraneoplastic
syndromes, some of which may antedate the development of a gross
pulmonary lesion. The hormones or hormone-like factors elaborated
include:      Antidiuretic hormone, including hyponatremia owing to
inappropriate ADH secretion Adrenocarticotropic hormone (ACTH) producing
Cushing syndrome Parathormone, parathyroid hormone-related peptide
prostagladin E, and some cytokines, all implicated in the hypercalcemia
often seen with lung cancer Calcitonin, causing hypocalcemia
Gonadotropins, causing gynecomastia Serotonin, associated with the
carcinoid syndrome.


  The incidence of clinically signicicant syndromes related to these
factors ranges from 1 to 10% of all lung cancer patients, although a much
hiher proportion of patients show elevated serum levels of these ( and
other ) peptide hormones. Any one of the histologic types of tumors may
occasionally produce any one of the hormones, but tumors producing ACTH
and ADH are predominantly small cell carcinomas, whereas those producing
hypercalcemia are mostly squamous cell tumors. The carcinoid syndrome is
associated rarely with small cell carcinoma but is more common with the
bronchial carcinoids.      Other systemic manifestations of bronchogenic
carcinoma include the Lambert Eaton myasthenic syndrome in which muscle
weakness is caused by autoimmune antibodies (possibly elicited by tumor
ionic channels) directed to the neuronal calcium channel, peripheral
neuropathy usually purely sensory; dematologic abnormalities including
acanthosis nigricans; hematologic abnormalities, such as leukemoid
reactions and finally a peculiar abnormality of connective tissue called
hypetrophic pulmonary osteoarthropathy associated with clubbing of the
fingers.      Apical lung cancer in the superior pulmonary sulcus tend to
invade the neural structures around the trachea including the cervical
sympathic plexus, and produce and group of clinical findings that
includes severe pain in the distribution of the ulnar nerve and Horner
syndrome (enopathalomos, ptosis, miosis, and anhidrosis) on the same
sitde as the lesion. Such tumors are also referred as Pancoast tumors.


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posted:11/24/2011
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