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INTRODUCTION

Both benign and malignant tumors of nonendocrine tissue can secrete a variety of hormones, principally peptide hormones, and many tumors produce more than one hormone (Table 83-1). At the clinical level, ectopic hormone production is important for two reasons.

TABLE 83-1PARANEOPLASTIC SYNDROMES CAUSED BY ECTOPIC HORMONE PRODUCTION

First, endocrine syndromes that result may either be the presenting manifestations of the neoplasm or occur late in the course. The endocrine manifestations in some instances are of greater significance than the tumor itself, as in pts with benign or slowly growing malignancies that secrete corticotropin-releasing hormone and cause fulminant Cushing's syndrome. The frequency with which ectopic hormone production is recognized varies with the criteria used for diagnosis. The most common syndromes of clinical import are those of adrenocorticotropic hormone (ACTH) hypersecretion, hypercalcemia, and hypoglycemia. Indeed, ectopic ACTH secretion is responsible for 15–20% of pts with Cushing's syndrome, and ~50% of pts with persistent hypercalcemia have a malignancy rather than hyperparathyroidism. Because of the rapidity of development of hormone secretion in some rapidly ...

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