Inappropriate vasopressin secretion and carcinoma of the pancreas

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      A fifty-nine year old man with a bronchogenic carcinoma (oat cell) demonstrated inappropriate antidiuresis: persistent urine hyperosmolality with marked serum hypoosmolality and hyponatremia in the presence of a normal blood volume, correction of hyponatremia with water restriction and excessive natriuresis with normal renal and adrenal function. Resection of the primary lung tumor did not ameliorate the antidiuretic hormone (ADH) syndrome. At autopsy, performed four months postoperatively, metastatic lung cancer was present in the liver and a separate tumor (adenocarcinoma) was found in the pancreas. Extracts of the pancreatic neoplasm contained very high levels of arginine vasopressin (380 milliunits (mU) per mg.) as demonstrated by both radioimmunoassay and biologic assay. Extracts from the primary lung tumor, lymph nodes involved by the lung tumor and metastatic lung tumor in the liver contained no detectable antidiuretic activity in both assays. In addition, pharmacologic analysis of the pancreatic carcinoma revealed a considerable quantity of oxytocin (500 mU per mg.). The values for arginine vasopressin (AVP) and oxytocin observed in the pancreatic neoplasm are in the same range as those present in the human neurohypophysis.
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