heterologous endocrine syndrome
Introduction
Introduction to heterologous endocrine syndrome Endometriosis syndrome refers to endocrine dysfunction caused by tumor-producing hormones or hormone-like peptides, and its mechanism involves cross-immunization, selective expression of oncogenes, etc. Some active substances secreted by certain tumors that cause endocrine symptoms. It has a hormone-like effect but no natural hormone can correspond to it (such as NSILA), so this syndrome can be called "ectopic endocrine syndrome" in a broad sense. The tumor-bearing endocrine syndrome can be used as the first symptom and sign of malignant tumor, and it can be used as a clue for early diagnosis. Some ectopic hormones can be used as clinical tumor markers to evaluate the curative effect and monitor tumor recurrence or progression. With molecular biology techniques With the continuous development, it is expected that new cancer treatment methods will be obtained through the study of ectopic hormones. basic knowledge The proportion of illness: 0.003%--0.007% Susceptible people: no special people Mode of infection: non-infectious Complications: hypoglycemia hypercalcemia
Cause
Cause of heterologous endocrine syndrome
Inhibition of gene shedding and translocation
The DNA code of normal cells is regulated by a suppressor gene, and only the relevant DNA is normally activated to transcribe to form mRNA and express normal gene products, but when malignant cells are formed, the suppressor gene is shed or translocated during mutation, and thus is inhibited normally. The DNA code can be de-inhibited to express the corresponding product (including hormones).
APUD cells
Tumors that secrete heterologous polypeptide hormones are derived from ectodermal neural crest stem cells. These cells have biochemical properties of amine and/or amine precursor uptake and decarboxylation, so they are called APUD cells. They themselves have genes that express various peptide hormones and biologically active amines, but the amount of normal is extremely small, and the corresponding genes are in a state of inhibition. Such non-endocrine cells can secrete trace hormones when they are normal, which can be regarded as Residues of low-level biological autocrine or paracrine information transmission systems. With the evolution of organisms, endocrine glands have differentiated into unique tissues, and there are corresponding regulatory systems. Non-endocrine cells also lose hormone secretion function with differentiation, related genes. It is in a state of inhibition, and once it forms cancer cells, it can restore its original autocrine properties and produce a large amount of corresponding peptides or amine active substances.
Prevention
Heterologous endocrine syndrome prevention
The tumor-bearing endocrine syndrome can be used as the first symptom and sign of malignant tumor, and it can be used as a clue for early diagnosis. Some ectopic hormones can be used as clinical tumor markers to evaluate the curative effect and monitor tumor recurrence or progression. With molecular biology techniques With the continuous development, it is expected that new cancer treatment methods will be obtained through the study of ectopic hormones.
Complication
Heterologous endocrine syndrome complications Complications hypoglycemia hypercalcemia
Including tumors originating from non-endocrine tissues, which produce certain hormones, or tumors that originate from the secretory gland (such as medullary thyroid carcinoma), except for hormones (such as calcitonin) that are secreted when the endocrine glands are normal. Also releases other hormones (such as ACTH), can develop antidiuretic hormone secretion syndrome, ectopic corticotropin syndrome, with tumor hypercalcemia, with tumor hypoglycemia, ectopic human gonadotropin secretion syndrome Wait.
Symptom
Symptoms of heterologous endocrine syndrome common symptoms nausea, abdominal distension, amenorrhea, hypokalemia, myocardium, illusion, coma
Clinical manifestations include abdominal distension, nausea, vomiting, polydipsia, loss of appetite, weakness of muscles, decreased muscle tone, myoclonus, etc. In severe cases, drowsiness, confusion, and even coma, dizziness, weakness, palpitation, tremors, and out Sweat, hunger, restlessness, insanity, hallucinations, headache, blurred vision, lack of exercise, ataxia, paralysis, convulsions in severe cases, even coma, acromegaly, etc. and precocious puberty, can cause in adult males Men's mammary gland development, the general symptoms are not obvious in adult women, sometimes can cause irregular uterine bleeding, a small number of lung cancer, kidney cancer can produce prolactin, causing galactorrhea and amenorrhea in women, causing sexual dysfunction and breast development in men, lung cancer, liver cancer Adrenal cortical cancer, adenocarcinoma, etc. can produce renin, clinical manifestations of hypertension, hypokalemia, increased aldosterone secretion, in addition, tumors can also ectopically secrete a variety of hormones such as erythropoietin, calcitonin, endothelium Sustaining causes the corresponding syndrome.
Examine
Heterologous endocrine syndrome
The following tests are helpful for the diagnosis of total endocrine syndrome tumors:
1. Determination of chromogranin A in blood: This protein can be produced by the entire cell hormone-producing cell system. If the result is positive, the tumor is present in this system and can be further examined.
2. Radionuclide-labeled octreotide scintigraphy: Most of the neuroendocrine cells that produce peptide hormones have somatostatin receptors, and the use of labeled somatostatin octapeptide analogues for scintigraphy contributes to tumors. Positioning.
3. The measured value of hormones in plasma and/or urine is increased, and the level is proportional to the blood supply of the tumor. The blood concentration of the venous blood is significantly increased from the blood supply to the artery or vein of the tumor.
Diagnosis
Diagnosis and identification of heterologous endocrine syndrome
Diagnostic criteria
With the advancement of laboratory methods, cases with no clinical ectopic endocrine symptoms can be diagnosed. The diagnostic criteria suitable for clinical or research work are as follows:
1. Tumor patients with hypersecretion syndrome, or increased plasma and / or urine hormone levels, the level is proportional to the tumor blood supply, blood samples from the supply of arteries or veins, venous blood hormone concentration is significant Increase.
2. The above-mentioned abnormal secretion of hormone secretion is not regulated by in vivo factors, nor can it be inhibited by a super-physiological amount of exogenous hormone (non-inhibitable).
3. It can rule out the normal function of the corresponding endocrine glands.
4. After anti-cancer treatment (tumor resection, radiotherapy or chemotherapy), the relevant endocrine group, hormone measurement value decreased, tumor recurrence or metastasis, the relevant syndrome and biochemical abnormalities can relapse.
5. The tumor tissue contains a confirmed hormone or contains a corresponding mRNA and can be expressed.
Differential diagnosis
Heterologous endocrine syndrome is common in elderly patients. Endocrine syndrome can occur in the early stage of the tumor, even before the tumor symptoms, so it can be regarded as an early stage group of certain tumors. Its peptide hormone or hormone-like substance can be used as a serological marker. Endocrine disorders can also occur in the late stage of the tumor, and should be taken into account in the diagnosis or differential diagnosis.
Distinguish between various primary adrenaline crises, hypercalcemia, hypoglycemia, acromegaly, hydrosis caused by improper secretion of antidiuretic hormones, etc.
