Gynaecomastia associated with gonadotrophin-secreting carcinoma of the lung

Abstract

Summary A 67-year-old man developed dermatomyositis. Investigation revealed an oat cell carcinoma of the lung. When he developed unilateral gynaecomastia this tumour was found to secrete gonadotrophins. The gynaecomastia disappeared after treatment with an anti-oestrogen--tamoxifen. This use of tamoxifen has not previously been described. Partial tumour regression was obtained with several cytotoxic drug regimes. His dermatomyositis responded to this treatment and remains in remission.

Dermatomyositis Associated with Lung Neuroendocrine Carcinoma

“…To analyze the published evidence, we conducted a systemic review, identifying 16 cases of dermatomyositis associated with lung neuroendocrine tumor (SCLC or LCNEC) reported as English full-text articles (Table) (20-35). Seven cases had been treated with chemotherapy, radiotherapy, and/or surgery for an existing tumor (21,23,25-29). Another four cases had been treated with corticosteroids alone or corticosteroids prior to chemotherapy (32-35), one case with corticosteroids and azathioprine (24), one case with intravenous immunoglobulin (IVIg) alone (30), and one case with corticosteroids and IVIg (31).…”

Gynecomastia

“…10,11 Studies of pubertal and adult gynecomastia require cautious interpretation because gynecomastia resolves spontaneously and most of the therapeutic trials do not use placebo controls for comparison. [182][183][184][185][186][187][188][189][190][191][192][193][194][195] Although these studies have had methodologic flaws, it appears that this class of drugs can be used safely and effectively in the short term for some pubertal boys and adult men with recent onset of gynecomastia. 177 Although the aromatase inhibitor decreased estradiol concentrations in the active treatment arm, the percentage of patients with decreased breast tissue diameter was 38.5% with anastrozole and 31.4% with placebo (P = not significant).…”

“…196,197 In men with idiopathic gynecomastia, carefully controlled randomized studies of medical therapy are limited. [184][185][186] Danazol, a weak androgen, and dihydrotestosterone, a nonaromatizable androgen, have also been shown in small trials to be modestly effective in the treatment of gynecomastia, but neither androgen is used commonly in the treatment of gynecomastia. Pain relief occurred in 9 in 10 on tamoxifen and 1 in 10 with placebo.…”

Paraneoplastic Syndromes in Lung Cancer

“…3,35,69,70 Cushing's syndrome is unusual and is seen only in patients with small cell carcinomas. 56 The infrequency of Cushing's syndrome is apparently related to the tumor production of immunoreactive or big ACTH (iACTH) rather than biologically active 4 Broder, 12 Coombes, 15 Fairlamb, 26 Floyd, 28 Genest, 30 Gropp, 35 Hansen, 37 Hattori, 39 Havemann, 41 McKenzie, 49 North, 52 Papapetrou, 53 and Yalow. 70 † 4 associated with immune complex ‡ 5 associated with HNP § All associated with HNP ACTH.…”