RESUMO
Renal phosphate wasting related to a tumor (oncogenous osteomalacia) is a rare disorder usually associated with benign mesenchymal tumors. In this article, the authors describe a man with renal phosphate wasting and the syndrome of inappropriate antidiuretic hormone associated with small cell carcinoma. Chemotherapy markedly reduced tumor burden and was associated with normalization of renal phosphate handling and serum sodium. With recurrence, renal phosphate wasting and the syndrome of inappropriate antidiuretic hormone developed again, with the additional complication of hypercortisolism secondary to ectopic corticotropin production. The authors report the rare occurrence of renal phosphate wasting with small cell carcinoma (5 previously reported cases) and the unique co-existence of this paraneoplastic syndrome with the syndrome of inappropriate antidiuretic hormone and ectopic corticotropin production.
Assuntos
Hormônio Adrenocorticotrópico/metabolismo , Carcinoma de Células Pequenas/complicações , Síndrome de Secreção Inadequada de HAD/etiologia , Neoplasias Pulmonares/complicações , Osteomalacia/etiologia , Carcinoma de Células Pequenas/fisiopatologia , Feminino , Humanos , Síndrome de Secreção Inadequada de HAD/fisiopatologia , Neoplasias Pulmonares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteomalacia/fisiopatologiaRESUMO
Fifteen individuals among four generations of a family of English ancestry demonstrated elevated hemoglobin levels accompanied by leftward-shifted whole blood oxygen equilibrium curves. Five of the affected family members have required phlebotomies for relief of symptoms attributable to erythrocytosis. An abnormal hemoglobin or globin chain could not be isolated, but 43% of the beta chains of the affected individuals contained a Leu----Phe substitution at position 105 (G7). Oxygen equilibrium curves demonstrated a normal Bohr effect but decreased cooperativity.