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Clinical assessment

Acromegaly due to ectopic growth secretion by a bronchial carcinoid responses to various stimuli

hormone-releasing hormone tumour. Dynamic hormonal

Glikson M, Gil-Ad I, Galun E, Dresner R, Zilberman S, Halperin Y et al. Heart Institute, Chaim Sheba Medical Centre, Tel’Hashomer IL- 52621. Acta Endwrinol 1991:125:366-71.

Ectopic GHRH is a relatively uncommon cause of acromegaly, which should be differentiated from pituitary adenoma, in order to avoid damage to the pituitary gland from unnecessary interventions. We report here on a 66-year-old man with acromegaly due to a GHRH- secreting bronchial carcinoid tumour, who recovered completely fol- lowing removal of the tumour. His hormonal status was studied before andafterdteoperation. BasalGH,GHRH, IGF-landPRLlevels,as well as plasma GH response to glucose load and TRH administration were abnormal before the operation, and became normal thereafter. The somatostatin analogue SMS 201995 was found to be a potent inhibitor of the ectopic GHRH and the GH secretion (>500 to 42 rig/l and 15.4 up/ I to 0.8 pg. respectively). The effect on GHRH proved to be due to direct effect of somatostatin on the tumour cells, as demonstrated in tissue culture studies. A mixed meal was found immediately to suppress GHRH levels without such an effect on GH secretion. We conclude that the neuroendocrine tests usually practised in acromegaly cannot differ- entiate between ectopic GHRH secretion and pituitary adenoma. High plasmaGHRHlevelsmay scrveasadiagnostictest forexcessiveGHRH production, which is almost always ectopic. These high levels are suppressible by somatostatin and a mixed meal.

Radioiodinated somatostatin analog scintigraphy in small-cell lung cancer KwekkeboomDJ,KrenningEP,BakkerWH,Oei HY,SplinterTAWet al. University Hospital Dijkzigt, 40 Dr. Molewaterplein, 3015 GD Rotterdam. 1 Nucl Med 1991;32:1845-8.

Somatostatin receptors have beon characterized on biopsy specimens from small-cell lung carcinoma (SCLC) and on cultured human SCLC cells. We recently described the in viva visualization of various soma- tostatin receptor-positive tumors, such as carcinoids and endocrine pancreatic tumors, after injection of ‘“I-Tyr-3-ocueotide, a radiolabe- led somatostatin analog. In the present study. this imaging procedure using ‘UI-Tyr-3-octreotide is reported in 11 patients with lung tumors. In live of eight patients with SCLC (63%), we were able to demonstrate tumor deposits using ‘%Tyr-3-ocneotide scintigraphy. Unexpected metastases were found in two patients. In one of three patients with SCLC in whom tumor was not visualized, nonvisualization may have been caused by tumor necrosis and recent radiotherapy. In one of two patients with malignant small-cell tumors as described by Askin, the neoplasm was visualized. Like SCLC, these tumors are thought to derive from neumendocrine cells. In one patient, a squamous-cell carcinoma and a bronchial adenoma were not visualized. We conclude that in the majority of patients with SCLC, the tumor and its metastases can be visualized using ‘UI-Tyr-3-ocueotide scintigraphy. However, the value of this new technique in terms of specificity and sensitivity requires further studies in a larger group of patients.

Concentration of carcinoembryonic antigen in bronchoalwolar lavage fluid: Its significance in lung cancer for early diagnosis Lasota A, Grubek-laworska H, Walajtys-Rode E. Zawitkowska H, Droszcz W. Dept. of Pneumonology. Warsaw Medical School, ul. Banacha la, 02-097 Warsaw. J Tumor Marker Oncol1991;6:107-13.

Thirty two patients with peripheral lung cancer suggested, by X-ray changes but not by bronchological examinations, divided into limited disease (M-O, n = 18) and extensive disease (M-l, n = 14) groups, were studied. Lung cancer diagnosis was verified by cytological or histopa- thologicalexamination. Conuolgroupconsistedof9 healthy volunteers and 28 patients with non-malignant pulmonary diseases. BAL-fluid CEA was assayed with RIA technique. The results wereexpressed in ng/

ml of recovered BAL-fluid. The highest serum CEA levels were seen in patients of advanced disease group (26.71 f 5.95, p<O,OOl), whereas CEA levels in sera of non-malignant pulmonary and limited diseases patients did not differ from the control group. On the other hand, highly significant increase of CEA concentration in BAL was found in both limited (71.11 f 7.23) and extensive (62.03 f 7.31) disease groups (p<O,COl), as compared with control. Hence, CEA estimation in BAL from patients with lung cancer may provide valuable screening test for a limited disease stage.

Primary lung cancer producing a-fetoprotein OkunakaT,KatoH,KonakaC,YamamotoH,FumkawaK.DeparIment of Surgery, Tokyo Medical College, 6-7-1, Nishishinjuku, Shinjuku-ku. Tokyo 160. Ann ‘Thorac Surg 1992;53:151-2.

Reports of a-fetoprotein-producing lung tumors are rare. Only 24 such patients with these tumors havebeen previously studied. We report the case of a patient with a large cell carcinoma of the lung and a serum a- fetoprotein level of 9,300 ng/mL, with no evidence of hepatic or other systemic abnormalities. Serum levels of a-fetoprotein returned to normal postoperatively.

Gonadal endocrine dysfunction in patients with lung cancer: Rela- tion to responsiveness to chemotherapy, respiratory function and performance status Aasebo U, Bremnes RM, Aakvaag A, Slordal L. Department of Chest Medicine, University Hospital of Tromso, Tromo. J Steroid Biochem Mel Biol 1991;39:375-80.

Male lung cancer patients with poor performance status [Pastern Cooperative Oncology Group (ECOG) index 3-4) have an endocrinol- ogical dysfunction as assessed by serum testosterone and sex hormone- binding globulin (SHBG) levels. Patients who respond to therapy regain normal free testostemne levels within 12 weeks post chemotherapy, whereas non-responders continue to exhibit subnormal levels. The perturbations of endoctinological variables in patients with lung cancer isnotdue todevelopmentof hypoxia, as patients with respiratory failure maintain a significantly lower testosterone level compared to cancer patients. The development of deficiency in total testosterone concentm- tions in lung cancer patients is correlated to their performance status, and not to the presence of metastatic disease. The mechanisms respon- sible for the endocrinological dysfunction in patients with lung cancer remain unknown.

Small-cell carcinoma ofthe lung: Derivation of a prognostic staging system Sagman U. Maki E. Evans W.K. Warr D. Shepherd F.A. Sculier J.P et al. Ontario Cancer Institute. 500 Sherbourne St, Toronto, Ont. M4X lK9. J Chn Oncol 1991;9:1639-49.

Retrospective data on 22 pretreatment attributes were evaluated in 614 patients with small-cell carcinoma of the lung (SCCL). The series included 284 patients with limited disease (LD) and 328 patients with extensive disease (ED) managed between 1974 and 1986. Prognostic factors were evaluated by univariate analysis and by the Cox multivari- ate regression model. Recursive partition and amalgamation algorithm f,RECPAM), two clustering methods well suited for obtaining strata and adapted for censoring survival data, were developed and used in the formulation of a new prognostic staging system. In univariate analysis, prognosis was significantly influenced by extent of disease (DE), the number of metastatic sites, and the detection of mediastinal spread in LD. Poor performance status (PS), male sex, and advanced age were negatively correlated with survival, as were increased serum levels of alkaline phosphates (AP), lactate dehydrogenase (LDH), carcinoem- bryonic antigen (CEA), total WBC count (WBCC), and low platelet count and low serum sodium. The Cox model identified plasma LDH and mediastinal spread as the only significant factors in LD; the influence of PS, number of metastatic sites, bone metastasis, brain metastasis, and platelet count were identified as significant in ED. The RECPAM model identified four distinct risk groups defined in a