Page 291 - TNFlipTest

Toronto Notes 2019 Paraneoplastic Syndrome Endocrinology E49 Paraneoplastic Syndrome
• clinicalsyndromesinvolvingnon-metastaticsystemiceffectsthataccompanymalignantdisease
• triggeredbyantibodiesagainstneoplasmcross-reactingwithnormaltissueorbyproductionofa
physiologically active substance by the neoplasm
• commonlypresentwithcancersoflung,breast,ovaries,orlymphaticsystem
Table 39. Clinical Presentation
Syndrome Class
Endocrine
Symptoms/Syndrome
Cushing’s syndrome
SIADH Hypercalcemia
Hypoglycemia Carcinoid
Lambert-Eaton myasthenic syndrome (LEMS)
Muscle weakness in limbs
Myasthenia gravis Fluctuating muscle weakness and fatiguability
Paraneoplastic limbic encephalitis
Depression, seizures, short- term memory loss
Hypokalemic nephropathy Nephrotic syndrome
Watery diarrhea Erythrocytosis
SLE
Scleroderma
Associated Malignancies
Small-cell lung cancer Pancreatic carcinoma Neural tumours Thymoma
Small-cell lung cancer CNS malignancies
Lung cancer
Breast carcinoma Renal cell carcinoma Multiple myeloma Ovarian carcinoma
Hepatocellular carcinoma Fibrosarcoma
Pancreatic carcinoma Gastric carcinoma
Small-cell lung cancer Thymoma
Small-cell lung cancer
Small-cell lung cancer
Lymphoma Melanomas
Medullary thyroid carcinomas
Renal cell carcinoma Hepatocellular carcinoma
Lymphomas
Lung cancer Breast carcinoma Gonadal carcinoma
Breast carcinoma Lung cancer Uterine cancer
Mechanism
Ectopic ACTH and ACTH- mimicking substance secretion
Antidiuretic hormone secretion
PTH-related protein, TGF-α, TNF secretion
Insulin or insulin-like substance secretion
Serotonin, bradykinin secretion Ab interferes with ACh release
Ab interferes with ACh release Unknown
Ectopic ACTH and ACTH-like substance secretion
Immunocomplex sedimentation in nephrons
Prostaglandin secretion EPO production
Anti-nuclear Ab production
Anti-nuclear Ab production
Neurologic
Renal
GI Hematologic
Rheumatologic
Investigations
• CBC,electrolytes,creatinine,LFTs,ALP,ESR,CRP,serum/urineelectrophoresis • serumautoantibodies,lumbarpuncture
• imaging:skeletalsurvey,CT,MRI,PETscan
• ±endoscopy
Treatment
• treatunderlyingtumour:surgery,radiation,chemotherapy
• treatimmune-mediateddisorder:IVIg,steroids,immunosuppressivedrugs,plasmapheresis(reserved
for patients with identifiable antibodies in serum)