Endocrine function in small cell undifferentiated carcinoma of the lung

Abstract

The endocrine status of 106 patients with undifferentiated small cell carcinoma of the lung was evaluated before treatment was begun. Almost one half of the patients had evidence of abnormal control of the secretion of adrenal cortical steroids, manifested by loss of diurnal rhythmicity or dexamethasone suppressibility. Only two had the clinical syndrome of ectopic ACTH secretion. Evidence of inappropriate secretion of vasopressin was found in 38% of the patients, most of whom also had abnormalities of corticosteroid secretory pattern. About one half of the patients had evidence of abnormal glucose tolerance, and many also had a paradoxical rise of plasma growth hormone concentration after glucose administration. The levels of the other hormones studies were normal. The pattern of hormone abnormality observed in these patients appears to be relatively specific for small cell undifferentiated carcinoma, and is different from that observed in other pulmonary tumors. Patients with abnormal control of plasma cortisol had a worse prognosis than those with normal adrenal function, largely because of decreased response rates to chemotherapy. Other endocrine abnormalities were of no prognostic significance.

Serum tumour markers in lung cancer: history, biology and clinical applications

“…The clinical picture of ectopic Cushing's syndrome is characterized by oedema, hypokalaemia or impaired glucose tolerance without obesity, striae and osteoporosis. Its frequency ranged 1-5% of 346 SCLC patients in five consecutive series [153][154][155][156][157]. Conflicting results have been reported concerning a possible correlation between serum levels of the hormone and stage of disease, treatment response, and survival of patients with lung cancer [150,151,155,158].…”

“…The concentration of ADH was elevated in 35% of 279 patients with SCLC [151,[165][166][167][168], whilst the frequency of the clinical syndrome was quite low (approximately 10% of 596 patients in six different studies [153][154][155][156][157]169]). Elevated serum levels of ADH did not correlate with the stage of disease [151], or with the response to treatment [158].…”

Small-Cell Lung Cancer Presenting as Diabetes Insipidus and Cushing's Syndrome

“…Although hypercortisolaemia has been documented to occur in up to 50% of case of SCLC [5], only 1.6% to 4.5% of patients with SCLC develop Cushing's syndrome [6]. The most frequent clinical findings, in ectopic ACTH syndrome, are peripheral oedema and proximal myopathy.…”

Management of paraneoplastic syndromes in lung cancer

“…The etiology in lung cancer is because of the abnormal production of ADH or an ADH-like substance by the cancer cells. It is thought that it carries no prognostic value [34]. • The mechanism of SIADH involves the binding of ADH to the receptors in the renal collecting system and ascending limb of the loop of Henle.…”