Heterologous ACTH

Introduction Heterologous ACTH is caused by inappropriate synthesis and secretion of bioactive hormones by tumors and causes corresponding clinical symptoms and signs. Originally named "ectopic" endocrine syndrome. Almost all non-endocrine tissues produce small amounts of different peptide hormones and hormone precursors. Non-endocrine tumors - hormone endocrine syndromes are not "ectopic" hormone production, which is a cancer-induced cell characteristic normally present in cancer-derived tissues. Zoomed in, renamed "heterologous" endocrine syndrome.

Cause

The cause of heterologous ACTH:

The clinical symptoms and signs are caused by the inappropriate synthesis and secretion of bioactive hormones by the tumor. Males are more common (male: female = 3:1), and occur in 40 to 60 years old. About half of them may have no Cushing sign, but cortisol may be increased, and 8 mg of dexamethasone per day cannot be inhibited.

Half of the disease is caused by lung cancer, mainly oat cell type. Only 3% of this type of lung cancer has Cushing sign. The lung cancer cells of this group are APUD cells, which can produce corresponding enzymes and convert POMC (macromolecule ACTH) into Active ACTH. Most lung cancers that produce ACTH have a high degree of malignancy and a short course of disease. Generally, the typical Cushing sign takes several months or even years, so slow growth tumors such as thymoma, bronchial carcinoid, pheochromocytoma or medullary thyroid carcinoma can appear in the months before the tumor is diagnosed. Sign. Bronchial carcinoid is a common occult disease, especially attention. The pigmentation of the patient is caused by the cleavage of -MSH by -LPH, ACTH and other peptide fragments containing MSH molecules. In fact, any cancerous tissue contains POMC, and most of the cancer patients have elevated POMC in the blood, but no clinical symptoms.

an examination

Related inspection

Serum potassium thyroid static imaging

Examination and diagnosis of heterogeneous ACTH:

Patients with cancer (especially with lung cancer), in addition to the symptoms of cancer (such as weight loss, fatigue, anemia), such as hypokalemia with alkalosis (potassium is not easy to correct), muscle weakness, edema, mental symptoms, pigmentation, Hypertension or impaired glucose tolerance should be suspected of heterologous ACTH syndrome. ACTH elevation can also be seen in 20% to 31% of patients with chronic obstructive emphysema and occasionally in other serious non-malignant lung diseases.

Differential diagnosis

Differential diagnosis of heterosexual ACTH confusing symptoms:

(1) Adrenal cortical hormone cell adenoma: clinical manifestations of body centripetal obesity, full moon face, buffalo back, multi-blood, abdomen thigh skin with purple lines, increased mane and so on. Heavier amenorrhea, loss of libido, general weakness, and even bedridden. Some patients have high blood pressure, diabetes and so on.

(2) Melanin-stimulating cell adenoma: very rare, only a few reported that the patient's skin is black and not accompanied by increased cortisol.

(3) malignant pituitary tumor: short history, rapid progression of the disease, not only the tumor grows up to compress the pituitary tissue, and invade to the surrounding, causing bone destruction of the saddle floor or immersion into the cavernous sinus, causing oculomotor nerve paralysis or abductor nerve paralysis. Sometimes the tumor penetrates the saddle to the sphenoid sinus, and the neurological symptoms are not obvious for a short period of time.

Patients with cancer (especially with lung cancer), in addition to the symptoms of cancer (such as weight loss, fatigue, anemia), such as hypokalemia with alkalosis (potassium is not easy to correct), muscle weakness, edema, mental symptoms, pigmentation, Hypertension or impaired glucose tolerance should be suspected of heterologous ACTH syndrome. ACTH elevation can also be seen in 20% to 31% of patients with chronic obstructive emphysema and occasionally in other serious non-malignant lung diseases.

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