Paraneoplastic Syndromes: Elements of Interest for the Urologist

Abstract

A paraneoplastic syndrome is a clinical condition in a patient affected by tumor which occurs distally from the primary neoplasia or its metastases, and is assessed via the humoral mediators. The uncommon secretion of peptide hormones is the most frequent cause of paraneoplastic syndromes. Although the symptoms are strongly varied, paraneoplastic endocrine syndromes are characterized by several functional features that differentiate them from the endocrine glands hyper-function related disorders. Based on the field's literature, the article presents the pathogenetic mechanisms, the laboratory and imaging features, and the essential therapeutic measures for humoral hypercalcemia of malignancy, hypercortisolism from ectopic ACTH/CRH production and water intoxication syndrome due to inadequate ADH secretion. Moreover, neuroendocrine differentiation in some urogenital cancers (prostate, bladder, kidney etc.), occurring as pure endocrine malignancy or as focal lesion, can develop a paraneoplastic carcinoid-like syndrome. On the other hand, some patients with urogenital tumors have increased serum levels of IGF-2 resulting in paraneoplastic hypoglycemia.