Paraneoplastic Syndromes Caused by Ectopic Hormone Production | ||
| PARANEOPLASTIC SYNDROME | ECTOPIC HORMONE | TYPICAL TUMOR TYPESa |
|---|---|---|
| Common | ||
| Hypercalcemia of malignancy | PTHrP | Squamous cell (head and neck, lung, skin), breast, genitourinary, gastrointestinal |
| 1,25 dihydroxyvitamin D | Lymphomas | |
| PTH (rare) | Lung, ovary | |
| PGE2 (rare) | Renal, lung | |
| SIADH | Vasopressin | Lung (squamous, small cell), gastrointestinal, genitourinary, ovary |
| Cushing's syndrome | ACTH | Lung (small cell, bronchial carcinoid, adenocarcinoma, squamous), thymus, pancreatic islet, medullary thyroid carcinoma |
| CRH (rare) | Pancreatic islet, carcinoid, lung, prostate | |
| Ectopic expression of GIP, LH/hCG, other G protein-coupled receptors (rare) | Macronodular adrenal hyperplasia | |
| Less Common | ||
| Nonislet cell hypoglycemia | IGF-II | Mesenchymal tumors, sarcomas, adrenal, hepatic, gastrointestinal, kidney, prostate |
| Insulin (rare) | Cervix (small cell carcinoma) | |
| Male feminization | hCGb | Testis (embryonal, seminomas), germinomas, choriocarcinoma, lung, hepatic, pancreatic islet |
| Diarrhea or intestinal hypermotility | Calcitoninc | Lung, colon, breast, medullary thyroid carcinoma |
| VIP | Pancreas, pheochromocytoma, esophagus | |
| Rare | ||
| Oncogenic osteomalacia | Phosphatonin (FGF23) | Hemangiopericytomas, osteoblastomas, fibromas, sarcomas, giant cell tumors, prostate, lung |
| Acromegaly | GHRH | Pancreatic islet, bronchial and other carcinoids |
| GH | Lung, pancreatic islet | |
| Hyperthyroidism | TSH | Hydatidiform mole, embryonal tumors, struma ovarii |
| Hypertension | Renin | Juxtaglomerular tumors, kidney, lung, pancreas, ovary |
| Consumptive hypothyroidism | Type 3 deiodinase | Hepatic hemangiomas |
a Only the most common tumor types are listed. For most ectopic hormone syndromes, an extensive list of tumors has been reported to produce one or more hormones.
b hCG is produced eutopically by trophoblastic tumors. Certain tumors produce disproportionate amounts of the hCG α or hCG β subunit. High levels of hCG rarely cause hyperthyroidism because of weak binding to the TSH receptor.
c Calcitonin is produced eutopically by medullary thyroid carcinoma and is used as a tumor marker.
Abbreviations: ACTH, adrenocorticotropic hormone; CRH, corticotropin-releasing hormone; FGF23, fibroblast growth factor 23; GH, growth hormone; GHRH, growth hormone-releasing hormone; GIP, gastric inhibitory peptide; hCG, human chorionic gonadotropin; IGF, insulin-like growth factor; LH, luteinizing hormone; PGE2, prostaglandin E2; PTH, parathyroid hormone; PTHrP, parathyroid hormone-related protein; SIADH, syndrome of inappropriate antidiuretic hormone secretion; TSH, thyroid-stimulating hormone; VIP, vasoactive intestinal peptide.