Cushing 症候群を合併したACTH産生肺小細胞癌の1例
症例は70歳の女性. 咳, 呼吸困難を主訴に入院. 胸部レ線および胸部CTにて左肺門部に腫瘤陰影を認め, 気管支鏡検査にて肺小細胞癌と診断された. 入院時より血中ACTH (2,000pg/ml), Cortisol (171.9μg/dl), 尿中17-OHCS (67mg/day) の高値, 低カリウム血症, アルカローシス, 高血糖, 中心性肥満, 全身の色素沈着が認められ典型的な Cushing 症候群と考えられた. さらに, 転移リンパ節生検標本の抗ACTH抗体による免疫染色の結果より, ACTH産生肺小細胞癌と診断された. VP-16およびCBDCA (またはCDDP) 併用による...
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| Published in | 日本胸部疾患学会雑誌 Vol. 34; no. 2; pp. 220 - 225 |
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| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English Japanese |
| Published |
社団法人 日本呼吸器学会
25.02.1996
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0301-1542 1883-471X |
| DOI | 10.11389/jjrs1963.34.220 |
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| Abstract | 症例は70歳の女性. 咳, 呼吸困難を主訴に入院. 胸部レ線および胸部CTにて左肺門部に腫瘤陰影を認め, 気管支鏡検査にて肺小細胞癌と診断された. 入院時より血中ACTH (2,000pg/ml), Cortisol (171.9μg/dl), 尿中17-OHCS (67mg/day) の高値, 低カリウム血症, アルカローシス, 高血糖, 中心性肥満, 全身の色素沈着が認められ典型的な Cushing 症候群と考えられた. さらに, 転移リンパ節生検標本の抗ACTH抗体による免疫染色の結果より, ACTH産生肺小細胞癌と診断された. VP-16およびCBDCA (またはCDDP) 併用による化学療法が施行され, 腫瘍は著明に縮小した. 腫瘍の縮小に伴い, 血中ACTHおよび, Cortisol は正常域に回復し, 色素沈着も消退した. 本症例は以後, 同併用化学療法を計6回施行し, 最終的にCRとなった. 一般に Cushing 症候群を合併した肺小細胞癌は易感染性で化学療法の効果が期待しにくいと言われるが, 本症例は化学療法が著効した症例であった. |
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| AbstractList | 症例は70歳の女性. 咳, 呼吸困難を主訴に入院. 胸部レ線および胸部CTにて左肺門部に腫瘤陰影を認め, 気管支鏡検査にて肺小細胞癌と診断された. 入院時より血中ACTH (2,000pg/ml), Cortisol (171.9μg/dl), 尿中17-OHCS (67mg/day) の高値, 低カリウム血症, アルカローシス, 高血糖, 中心性肥満, 全身の色素沈着が認められ典型的な Cushing 症候群と考えられた. さらに, 転移リンパ節生検標本の抗ACTH抗体による免疫染色の結果より, ACTH産生肺小細胞癌と診断された. VP-16およびCBDCA (またはCDDP) 併用による化学療法が施行され, 腫瘍は著明に縮小した. 腫瘍の縮小に伴い, 血中ACTHおよび, Cortisol は正常域に回復し, 色素沈着も消退した. 本症例は以後, 同併用化学療法を計6回施行し, 最終的にCRとなった. 一般に Cushing 症候群を合併した肺小細胞癌は易感染性で化学療法の効果が期待しにくいと言われるが, 本症例は化学療法が著効した症例であった. |
| Author | 萩本, 直樹 原, 信之 中西, 洋一 高野, 浩一 高山, 浩一 中野, 寛行 |
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| References | 11) Farrell WE, Clark AJL, Stewart MF, et al: Bromocriptine inhibits pro-opiomelanocortin mRNA and ACTH precursor section in small cell lung cancer cell lines. J Clin Invest 1992; 90: 705. 3) Jacob JL: The frequency and clinical biology of the ectopic hormone syndromes of small cell carcinoma. Cancer 19821; 50: 2111. 4) Frances AS, Jennifer L, William KE, et al: Cushing's syndrome associated with ectopic corticotropin production and small-cell lung cancer. J Clin Oncol 1992; 10: 21. 9) Singer W, Kovacs K, Ryan N, et al: Ectopic ACTH syndrome: Clinicopathological correlations. J Clin Pathol 31: 591, 1978. 6) Frances AC, Paul DW, Martin B: Management of patients with small cell carcinoma and the syndrome of ectopic corticotropin secretion. Cancer 1994; 73: 1361. 2) Brown WH: A case of pluriglandular syndrome: Diabetes of bearded women. Lancet 1928; 2: 1022. 15) Mogens H, Mogens H, Lotte H: ACTH, ADH, and calcitonin concentrations as markers of response and relapse in small-cell carcinoma of the lung. Cancer 1980; 46: 2062. 12) Nicoletta S: The use of ketoconazole as an inhibitor of steroid production. N Engl J Med 1987; 317: 812. 7) Meletios AD, Jose FF, Naguib AS, et al: Paraneoplastic Cushing's syndrome as an adverse prognostic factor in patients who die early with small cell lung cancer. Cancer 1992; 69: 66. 10) George G, Rosalyn Y: Ectopic ACTH production in carcinoma of the lung. J Clin Invest 1974; 53: 1022. 1) Kent RJ, Jonathan AH, Paul CC: Diagnostic and therapeutic aspects. Am J Surg 1985; 149: 276. 5) Line D, Michael JB, David W, et al: Ectopic corticotropin syndrome and small-cell carcinoma of the lung. Arch Intern Med 1993; 153: 746. 8) Howlett TA, Drury PL, Perry L, et al: Diagnosis and management of ACTH-dependent Cushing's syndrome: Comparison of the features in ectopic and pituitary ACTH production. Clinic Endocrinol 1986; 24: 699. 14) Martin DA, Donald LT, Stephen BB: Ectopic adrenocorticotropic (ACTH) syndrome and small cell carcinoma of the lung—Assessment of clinical implications in patients on combination chemotherapy. Cancer 1981; 48: 1082. 13) Hoffman DM, Brigham B: The use of ketoconazole in ectopic adrenocorticotrophic hormone syndrome. Cancer 1991; 67: 1447. |
| References_xml | – reference: 14) Martin DA, Donald LT, Stephen BB: Ectopic adrenocorticotropic (ACTH) syndrome and small cell carcinoma of the lung—Assessment of clinical implications in patients on combination chemotherapy. Cancer 1981; 48: 1082. – reference: 10) George G, Rosalyn Y: Ectopic ACTH production in carcinoma of the lung. J Clin Invest 1974; 53: 1022. – reference: 13) Hoffman DM, Brigham B: The use of ketoconazole in ectopic adrenocorticotrophic hormone syndrome. Cancer 1991; 67: 1447. – reference: 7) Meletios AD, Jose FF, Naguib AS, et al: Paraneoplastic Cushing's syndrome as an adverse prognostic factor in patients who die early with small cell lung cancer. Cancer 1992; 69: 66. – reference: 9) Singer W, Kovacs K, Ryan N, et al: Ectopic ACTH syndrome: Clinicopathological correlations. J Clin Pathol 31: 591, 1978. – reference: 3) Jacob JL: The frequency and clinical biology of the ectopic hormone syndromes of small cell carcinoma. Cancer 19821; 50: 2111. – reference: 4) Frances AS, Jennifer L, William KE, et al: Cushing's syndrome associated with ectopic corticotropin production and small-cell lung cancer. J Clin Oncol 1992; 10: 21. – reference: 1) Kent RJ, Jonathan AH, Paul CC: Diagnostic and therapeutic aspects. Am J Surg 1985; 149: 276. – reference: 5) Line D, Michael JB, David W, et al: Ectopic corticotropin syndrome and small-cell carcinoma of the lung. Arch Intern Med 1993; 153: 746. – reference: 8) Howlett TA, Drury PL, Perry L, et al: Diagnosis and management of ACTH-dependent Cushing's syndrome: Comparison of the features in ectopic and pituitary ACTH production. Clinic Endocrinol 1986; 24: 699. – reference: 6) Frances AC, Paul DW, Martin B: Management of patients with small cell carcinoma and the syndrome of ectopic corticotropin secretion. Cancer 1994; 73: 1361. – reference: 15) Mogens H, Mogens H, Lotte H: ACTH, ADH, and calcitonin concentrations as markers of response and relapse in small-cell carcinoma of the lung. Cancer 1980; 46: 2062. – reference: 2) Brown WH: A case of pluriglandular syndrome: Diabetes of bearded women. Lancet 1928; 2: 1022. – reference: 12) Nicoletta S: The use of ketoconazole as an inhibitor of steroid production. N Engl J Med 1987; 317: 812. – reference: 11) Farrell WE, Clark AJL, Stewart MF, et al: Bromocriptine inhibits pro-opiomelanocortin mRNA and ACTH precursor section in small cell lung cancer cell lines. J Clin Invest 1992; 90: 705. |
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| SubjectTerms | Cushing 症候群 化学療法 肺小細胞癌 |
| Title | Cushing 症候群を合併したACTH産生肺小細胞癌の1例 |
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