Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 36 year old woman with hypercorticism and markedly elevated blood ACTH levels underwent pituitary ablation because of suspected hypophysial Cushing's disease. Since no adenoma was detected in the anterior lobe and the hypercorticism persisted, a bilateral adrenalectomy was performed. Four months later lymph node and mediastinal metastases of an anaplastic small cell carcinoma, with the presence of argyrophil granulation, as well as immunoreactive 19-39ACTH, beta-LPH and alpha-endorphin, were found. The primary site of ectopic ACTH production was not revealed. A light and electron microscopic study of the adrenals, in addition to cortical hyperplasia, disclosed numerous small cells associated with nonmyelinated sympathetic nerve fibers and containing cytoplasmic inclusions indistinguishable from Reinke crystals. The Leydig-like cell-nonmyelinated nerve complexes, noted in both the adrenal cortex and medulla, showed perivascular localization, and their morphologic features were similar to those of hilus cells of the ovaries or extraglandular Leydig cells of the testis. The underlying mechanism accounting for the development of Leydig-like cells remained obscure; cytodifferentiation from pluripotent mesenchymal cells, possibly mediated by secretory products of sympathetic nerve fibers, may provide an explanation for their formation.
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PMID:Leydig-like cells in the adrenals of a woman with ectopic ACTH syndrome. 719 May 43

A case of adrenal insufficiency secondary to metastatic colonic carcinoma is reported. Because the patient was taking prednisone for an unrelated condition, his initial presentation mimicked isolated aldosterone deficiency with an elevated serum potassium of 8.7 mmol/l. Cortisol deficiency was documented by ACTH testing. The diagnosis of metastatic disease causing adrenal insufficiency was suspected after a computed body scan of the abdomen revealed marked bilateral adrenal enlargement. Adrenal insufficiency secondary to metastatic cancer is reviewed.
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PMID:Adrenal insufficiency from metastatic colonic carcinoma masquerading as isolated aldosterone deficiency. Report of a case and review of the literature. 730 81

Ectopic ACTH secretion is a rare cause of hypercortisolism. Induced metabolic disturbances are often serious, and the management of such patients may be difficult. We report here our experience with four medullary thyroid carcinoma (MTC) patients with distant metastases in whom an ectopic ACTH syndrome occurred. The clinical presentation was significant by the severity and the rapidity of the hypercortisolism. Diagnosis and follow-up were realized by measurements of plasma cortisol, urinary free cortisol, urinary 17-hydroxycorticosteroid, plasma ACTH, plasma LPH, serum calcitonin and carcino-embryonic antigen. Initial treatment with adrenalytic medical therapy failed to control the disease. Only bilateral adrenalectomy cured the excessive cortisol production, and for a long time despite tumor progression. In conclusion, bilateral adrenalectomy should be considered in MTC patients with Cushing's syndrome even at the stage of distant spread. In fact, with regard to the slow growth rate of most MTC's, they may survive for years.
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PMID:Cushing's syndrome in medullary thyroid carcinoma. 761 3

Carcinoid tumour of the thymus is a rare condition, with less than a hundred cases reported in the literature. Diagnosis is complex as they are usually asymptomatic. We describe a case of a severe Cushing syndrome developed in a 51-year-old man. The diagnosis of a thymic carcinoid was established. Three years ago, the patient was treated by surgical resection of an anterior mediastinal mass. A massive tumour dissemination was detected by MIBG and CT image techniques. Both techniques are currently considered useful for this kind of diagnosis. ACTH secretion was detected immunohistochemically. Although the treatment with SMS-201-995 octreotide was effective in controlling the clinical symptoms, the patient died three months later with extensive metastases. The carcinoid tumours of the thymus associated to Cushing syndrome are aggressive tumours and usually produce local and distant metastases.
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PMID:[An ACTH-secreting carcinoid tumor of the thymus. A report of a new case]. 762 65

Ectopic ACTH syndrome represents a cancer-induced amplification of a property [proopiomelanocortin (POMC) peptides production] normally present in the cells from which the cancer originated but with aberrant posttranslational processing of POMC resulting in a greatly elevated secretion of ACTH precursors. The classic ectopic ACTH-producing tumors described in the 1960s were highly malignant but more recently slowly growing tumors such as carcinoids are reported with increasing frequency. Clinical features of patients with ectopic ACTH were analyzed, including biochemical abnormalities, plasma ACTH, cortisol and urinary steroids. Dynamic tests such as high-dose dexamethasone suppression, metyrapone and ovine-CRH (oCRH) stimulation were explored, as well as inferior petrosal sinus ACTH sampling before and after oCRH. Among the tumor markers examined, elevation of ACTH precursors was uniformly present followed by increased output of calcitonin, gut hormones, oncofetal and placental hormones in decreasing order. Since more than 90% of ectopic ACTH tumors are neuroendocrine in nature exhibiting APUD characteristics, their 2 markers, neuron-specific enolase and chromogranins are very useful. The imaging procedures for localization of the tumor ranged from chest X-rays to computed tomography and magnetic resonance of the chest and abdomen. Abdominal ultrasonography was also useful. Finally somatostatin receptor scintigraphy permitted demonstration of unrecognized tumors and/or metastases, even when the tumors were occult. The ACTH content, immunostaining for APUD markers and altered POMC processing were evaluated in ectopic tumors and/or metastases. Occult ectopic ACTH syndrome of more than 4-6 months of symptoms without the emergence of an obvious source was reviewed. Since the tumors are often clinically and biochemically undistinguishable from pituitary-dependent Cushing's disease, inferior petrosal sinus sampling for ACTH after oCRH stimulation established the diagnosis in over 90% of the cases. 60% of the occult tumors were thoracic carcinoids (3/4 bronchial carcinoids), followed by small cell lung cancer and pancreatic neuroendocrine tumors. In 12% the primary etiology was not detected. The rare syndrome of ectopic CRH syndrome (6 published cases) leading to excessive stimulation of the pituitary which became hyperplastic and secreted excessive amounts of ACTH is discussed. Finally, the 12 published cases and 1 unreported patient with ectopic CRH-ACTH tumors were reviewed, the majority being metastatic small cell lung carcinomas, bronchial and thymic carcinoids.
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PMID:Ectopic ACTH syndrome. 762 46

ARIMIDEX is a potent and selective aromatase inhibitor undergoing evaluation as a treatment for postmenopausal women with advanced breast cancer. Studies examining the pharmacology of ARIMIDEX were conducted in both animals and humans. In animals, ARIMIDEX elicits maximal aromatase suppressive activity at a dose of approx. 0.1 mg/kg, does not alter adrenal steroid hormone biosynthesis, and at a dose of 1 mg/kg, has no other pharmacologic effects other than aromatase inhibition. In this overview, the pharmacodynamic, pharmacokinetic, and safety profiles of single and multiple daily doses of ARIMIDEX are reported in humans. Daily doses of 1-10 mg of ARIMIDEX suppressed estradiol levels to the maximum degree measurable using sensitive estrogen assays. ARIMIDEX had no clinically significant effects on the response of cortisol and aldosterone to ACTH stimulation. Absorption of ARIMIDEX was rapid, with maximum plasma concentrations occurring within 2 h after oral administration. Plasma concentrations of ARIMIDEX rose with increasing doses of the drug. The elimination half-life of ARIMIDEX in humans ranged from 30 to 60 h. Consistent with the long plasma half-life, steady state plasma concentrations were 3-4-fold higher than plasma concentrations observed after single administration of 1, 3, 5, or 10 mg doses. Long term treatment of breast cancer patients with 10 mg/day has continued in 17 patients without an escape of estradiol suppression. Previously, these patients had received on average 2.6 systemic treatments for breast cancer and had significant metastatic disease. Three of the 17 patients continued ARIMIDEX treatment for 20 months and beyond. Given the number of previous treatments and tumor burden at the start of treatment, the response to ARIMIDEX treatment is encouraging. Phase III studies are now underway to assess the efficacy and safety of ARIMIDEX in the treatment of advanced breast cancer.
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PMID:ARIMIDEX: a new oral, once-a-day aromatase inhibitor. 762 50

The use of immunohistochemistry and electron microscopy enables the strict separation of adreno-cortical and adreno-medullary tumors in every case, as tumors of the medulla are generally positive for neuroendocrine markers (chromogranin A, synaptophysin) and negative for D11 whereas those of the cortex are stained with D11 and are negative with the other markers. Our surgical collection of cortical tumors and tumor-like lesions (n = 104) covers adenomas (39%), carcinomas (15%), microadenomatosis (2%), macronodular hyperplasia (4%), hemangioma (1%), myelolipoma (2%), hematoma (1%), pseudocysts (2%), and metastases (6%). The often difficult interpretation of dignity was aided by a point system of criteria. Isolated nodules were differentiated from adenomas by their size (ie less than 3 cm), the histological pattern and the lack of cellular atypia. Correlations of the lesions with the endocrine functions were presented. The tumors of the medulla (n = 42) were differentiated in pheochromocytomas (88%), malignant pheochromocytomas (7%), neuroblastomas (2%), and ganglioneuroblastomas (2%). 8-10% of pheochromocytomas are malignant, but with the exception of invasion of the capsule or of the veins or the demonstration of metastases, no other reliable criteria for malignancy exist. The lack of S100-protein-immunoreacting satellite cells may indicate a malignant growth. 89% of pheochromocytomas in our collection were shown to be endocrine active secreting catecholamines and in one case additionally ACTH.
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PMID:Pathology of adrenal neoplasms. 765 Dec 77

High numbers of high-affinity somatostatin binding sites have been found on carcinoid tumors, gastrinomas, small cell lung cancers and the majority of medullary thyroid cancers, enabling in vivo visualization of these tumors with octreotide scintigraphy. A comparison of the results obtained at our institution and another 15 centers in Europe show a few remarkable similarities and differences. The overall sensitivity of octreotide receptor scintigraphy to detect the primary GEP tumor and its metastases is high, e.g. 80-90%. The main difference was found in gastrinomas and to a lesser extent in insulinomas. These differences might be attributed to different scanning protocols. Furthermore, octreotide scintigraphy also has a high sensitivity to localize the primary tumor and its metastases causing Cushing's syndrome by ectopic production of ACTH or CRH. Octreotide scintigraphy is a new, sensitive and noninvasive technique to localize somatostatin receptor expressing endocrine tumors and their metastases.
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PMID:Somatostatin receptor scintigraphy in carcinoids, gastrinomas and Cushing's syndrome. 769 38

A 34-year-old male developed multiple intracranial and intraspinal metastases from an invasive ACTH secreting pituitary adenoma. He was initially admitted to our hospital complaining of visual loss 10 years ago, presenting a pituitary tumor with suprasellar extension. At first, transsphenoidal surgery was performed, and histological finding was pituitary apoplexy. He developed recurrence of the tumor 2 times. At the second, third and fourth operation, the histological finding was an ACTH secreting pituitary adenoma with atypia. Metastases within the central-nervous system of pituitary adenoma is a rare entity and only 21 cases have been published. A review of previously published cases follows.
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PMID:[ACTH producing pituitary adenoma with multiple intracranial metastases and spinal dissemination]. 770 Apr 93

Pituitary metastases constitute 1% to 8.3% of all metastatic brain tumors. The most frequent localization is in the posterior lobe and diabetes insipidus may be the only symptom of dysfunction. Cerebral aspergillosis is an unusual disease and it has been described complicating an underlying malignancy or following intracraneal surgery. We describe a case of hypopituitarism and hyperprolactinemia in a patient with pituitary metastases of a colon carcinoma and aspergillosis. Two years before a colon adenocarcinoma (Class C1 of Duke) had been resected. There were no clinical signs of hypopituitarism or galactorrea. The laboratory findings showed deficiency of cortocotropin (ACTH), luteinizing hormone (LH), follicle stimulating hormone (FSH) and slight hyperprolactinemia (PRL). Cerebral magnetic resonance image (MRI) revealed an intra and suprasellar mass which extended to the hypothalamus. Chest X-ray film and computed tomographic scanning (TC) confirmed a macronodular mass at the apical segment of the inferior left lung lobule with mediastinal hypertrophic lymph nodes. A non functional pituitary tumor was diagnosed and transphenoidal surgery was carried out. At microscopic examination a malignant proliferation was found suggesting colonic differentiation. Fragments of tumoral pituitary tissue showed hyphae of aspergillus in the form of abscess. Aspergillosis complicating neoplastic disease is more often present in leukemia and lymphoma than in solid tumors.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Hypopituitarism caused by colonic carcinoma metastasis associated with hypophysial aspergillosis]. 785 93


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