Paraneoplastic Syndromes

Question 1

Mechanism, treatment, and assoc’d tumor types of PNS:

Hypercalcemia of malignancy (HM)

Answer 1

Mech:

1) PTHrp
- lymphoma and asapac
2) IL-1beta (osteoclast activating factor)
- multiple myeloma

Tx:

• need to treat the underlying malignancy!
• aggressive fluid diuresis with 0.9% NaCl –> once rehydrated… furosemide, pred, bisphosphonates

Assoc’d tumor types:

• Lymphoma (mediastinal, Tcell)
• ASAGAC
• Mutiple myeloma

Question 2

Mechanism, treatment, and assoc’d tumor types

Hypoglycemia

Answer 2

Mech:

• inc insulin production
• insulin-like growth factor (IGF1 & IGF2)

Tx: Need to treat the underlying malignancy!

• small, frequent meals
• pred
• other meds? ($$)

Asso’d tumor types:

• Insulinoma!
• Hepatocellular carcinoma
• Leiomyosarcoma

Question 3

Mechanism, treatment, and assoc’d tumor types

Hypertrophic osteopathy (HO)

Answer 3

Mech:

• periosteal proliferation along extremities –> digits and up
• multifactorial and poorly understood

Tx:

• remove lung mass
• analgesics (be aggressive)
• vagotomy?
• biphosphates - if secondary to mets dz –> euth may be considered

Assoc’d tumor types:

• primary lung tumors
• metastatic lung tumors