title: Ectopic secretion of chorionic gonadotropin by a lung carcinoma. Pituitary gonadotropin and subunit secretion and prolonged chemotherapeutic remission.
abstract: The ability of tumor markers to improve cancer therapy is not established. We studied a man with a human chorionic gonadotropin (HCG)-secreting large cell carcinoma of the lung and gynecomastia. Preoperatively, levels of HCG (109 ng/ml), its alpha and beta subunits (3.2 and 21 ng/ml, respectively) and plasma estradiol were elevated. Despite apparently complete tumor resection and total resolution of gynecomastia, HCG titers remained elevated (3.3 ng/ml), heralding tumor recurrence three weeks later. Because the pathophysiologic consequences of the ectopic secretion of HCG on pituitary function are not established, we administered 100 microgram of gonadotropin-releasing hormone (LHRH) and observed a markedly delayed increase in pituitary gonadotropins. Early chemotherapy, guided by persistence of HCG, reduced HCG to undetectable levels, restored to normal the response to LHRH and resulted in a distinctly unusual 30-month complete remission. Use of HCG as a tumor marker levels is more sensitive than the symptom of gynecomastia and may permit detection of small, potentially curable tumor foci.
mesh_terms: D018288:Carcinoma, Small Cell / Q000175:diagnosis / Q000378:metabolism*; D006063:Chorionic Gonadotropin / Q000378:metabolism*; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006177:Gynecomastia / Q000209:etiology; D006729:Hormones, Ectopic / Q000378:metabolism*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009384:Paraneoplastic Endocrine Syndromes / Q000175:diagnosis / Q000378:metabolism; D010906:Pituitary Hormone-Releasing Hormones; D012075:Remission, Spontaneous
chemical_list: D006063:Chorionic Gonadotropin; D006729:Hormones, Ectopic; D010906:Pituitary Hormone-Releasing Hormones; D004317:Doxorubicin; D003520:Cyclophosphamide