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Small cell carcinoma with two paraendocrine syndromes
S T Pierce1, M Metcalfe, E R Banks
1Department of Internal Medicine, University of Kentucky Medical Center, Lexington 40536-0084.
Cancer
|May 1, 1992
Summary
This study reports a rare case of small cell carcinoma (SCC) with simultaneous ectopic arginine vasopressin (AVP) and adrenocorticotropin (ACTH) production. Immunohistochemical staining confirmed both hormones in the tumor, highlighting a unique paraendocrine presentation.
Area of Science:
- Endocrinology
- Oncology
- Pathology
Background:
- Paraendocrine syndromes, involving ectopic hormone production, are frequently associated with small cell carcinoma (SCC).
- Ectopic adrenocorticotropin (ACTH) and arginine vasopressin (AVP) production are known, but their simultaneous occurrence is exceptionally rare.
Observation:
- A patient with small cell carcinoma (SCC) presented with simultaneously elevated plasma levels of ectopic arginine vasopressin (AVP) and ectopic adrenocorticotropin (ACTH).
- This presentation fulfills the diagnostic criteria for both the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and ectopic ACTH syndrome.
Findings:
- This case represents the first documented instance in English-language literature of elevated plasma levels of both AVP and ACTH in a single patient with SCC.
- Immunohistochemical staining of the patient's neoplasm confirmed the presence of both ectopic ACTH and AVP within the tumor cells.
- Hormone levels were monitored throughout the patient's treatment, correlating with disease progression and refractoriness to therapy.
Implications:
- The simultaneous presence of these two paraendocrine syndromes in SCC is a rare but significant finding.
- Monitoring ectopic hormone levels (ACTH and AVP) can serve as a valuable adjunct to radiographic methods for assessing therapeutic response in SCC patients.
- This case underscores the complex endocrine manifestations of small cell carcinoma and their prognostic implications.