Endocrine paraneoplastic syndromes in patients with lung cancer

Paraneoplastični su sindromi skupina karakterističnih kliničkih sindroma uzrokovanih malignom bolešću. Oni su posljedica ektopičnog izlučivanja hormona, funkcionalnih peptida i citokina iz zloćudnog primarnog tumora ili križne reakcije tumorskih stanica s normalnim stanicama domaćina. Ovaj pojam ne uključuje kliničke poremećaje uzrokovane direktnim rastom i infiltracijom primarnog tumora, kao ni one uzrokovane razvojem metastaza. Paraneoplastični sindromi najčešće su uzrokovani karcinomima pluća, posebice sitnostaničnim karcinomom pluća. U pacijenata sa zloćudnim tumorima pluća na prvom su mjestu paraneoplastični sindromi endokrinološke prirode. Simptomi ovih sindroma nerijetko prethode postavljanju dijagnoze samoga tumora, pa igraju značajnu ulogu u ranom identificiranju zloćudnih tumora pluća. Mjerenje sekretornih komponenti odgovornih za nastanak paraneoplastičnih sindroma može služiti i praćenju kliničkog tijeka bolesti te odgovora na liječenje karcinoma. Najčešći su endokrinološki paraneoplastični poremećaji u pacijenata s karcinomom pluća maligna hiperkalcemija, sindrom neprimjerenog lučenja antidiuretskog hormona, ektopični Cushingov sindrom, hipoglikemija te karcinoidni sindrom. Oni se dijagnosticiraju pomoću specifičnih kriterija. Povezani su sa lošijom prognozom, povećanjem tereta bolesti te značajnim smanjenjem kvalitete života, pa ih je potrebno što ranije dijagnosticirati te adekvatno liječiti.
Paraneoplastic syndromes are a group of characteristic clinical syndromes caused by a malignant disease. They are caused by secretion of hormones, functional peptides and cytokines by a primary malignant tumor or are secondary to cross reactivity of tumor cells with normal host cells. This term does not include clinical disorders caused by the direct growth and infiltration of the primary tumor, nor does it include those caused by the development of metastases. Paraneoplastic syndromes are most commonly caused by lung cancer, especially small cell lung cancer. The most frequent paraneoplastic syndromes in patients with malignant lung tumors are endocrine. As the symptoms of these syndromes oftentimes precede the diagnosis of the tumor itself, they play a significant role in early identification of malignant lung tumors. Measuring of secretory components responsible for the development of paraneoplastic syndromes can be used to monitor the clinical course of the disease and the response to cancer treatment. The most common endocrine paraneoplastic sydromes in patients with lung cancer are hypercalcemia of malignancy, syndrome of inappropriate antidiuretic hormone secretion, ectopic Cushing’s syndrome, hypoglycemia and carcinoid syndrome. Specific criteria are used for their diagnosis. They are associated with a poorer prognosis, increased disease burden and a significant decrease in quality of life. Thus, they need to be diagnosed as early as possible and treated adequately and swiftly.