Paraneoplastic & Endocrine Syndromes

Paraneoplastic Cushing syndrome

Develops when tumours produce ACTH, or an ACTH analogue. May present with typical Cushing syndrome features, plus abnormal pigmentation from the ACTH effect. Seek specialist palliative care advice.

Ectopic insulin/insulin-like factor secretion

Insulinomas (islet cell tumours) secrete insulin directly; more commonly, other tumours secrete insulin-like factors. Either can present as hypoglycaemia.

Carcinoid syndrome

A histamine- and/or serotonin-secreting tumour, presenting with wheezing, flushing and diarrhoea — most commonly in patients with liver metastases from carcinoid-type tumours of the gut, pancreas or lungs.

• Reducing tumour load can relieve symptoms; active anticancer treatment may be an appropriate palliative approach in itself.
• Somatostatin analogues (octreotide, lanreotide) can help symptomatically — preventing flushing, diarrhoea and other endocrine manifestations.
• Usually managed by the patient’s oncologist.