Advertisement

Inappropriate vasopressin secretion and carcinoma of the pancreas

      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Winkler A.W.
        • Crankshaw O.F.
        Chloride depletion in conditions other than Addison's disease.
        J. Clin. Invest. 1938; 17: 1
        • Schwartz W.B.
        • Bennett W.
        • Curelop S.
        • Bartter F.C.
        A syndrome of renal sodium loss and hyponatremia probably resulting from inappropriate secretion of antidiuretic hormone.
        Am. J. Med. 1957; 23: 529
        • Leaf A.
        • Bartter F.C.
        • Santos R.F.
        • Wrong O.
        Evidence in man that urinary electrolyte loss induced by pitressin is a function of water retention.
        J. Clin. Invest. 1953; 32: 868
        • Thorn N.A.
        • Transbol I.
        Hyponatremia and bronchogenic carcinoma associated with renal excretion of large amounts of antidiuretic material.
        Am. J. Med. 1963; 35: 257
        • Bower B.F.
        • Mason D.M.
        • Forsham P.H.
        Bronchogenic carcinoma with inappropriate antidiuretic activity in plasma and tumor.
        New England J. Med. 1964; 271: 934
        • Barraclough M.A.
        • Jones J.J.
        • Lee J.
        Production of vasopressin by anaplastic oat cell carcinoma of the bronchus.
        Clin. Sc. 1966; 31: 135
        • Amatruda Jr., T.T.
        • Mulrow P.J.
        • Gallagher J.C.
        • Sawyer W.H.
        Carcinoma of the lung with inappropriate antidiuresis. Demonstration of antidiuretic-hormone-like activity in tumor extract.
        New England J. Med. 1963; 269: 544
        • De Sousa R.C.
        • Delaere J.
        • Berde B.
        Inappropriate secretion of vasopressin.
        Lancet. 1965; 1: 436
        • Utiger R.D.
        Inappropriate antidiuresis and carcinoma of the lung: detection of arginine vasopressin in tumor extracts by immunoassay.
        J. Clin. Endocrinol. 1966; 26: 970
        • Bangham D.R.
        • Mussett M.V.
        Third international standard for posterior pituitary.
        Bull. World Health Organ. 1958; 19: 325
        • Jeffers W.A.
        • Livezey M.M.
        • Austin J.H.
        A method for demonstrating an antidiuretic action of minute amounts of pitressin: statistical analysis of results.
        in: Proc. Soc. Exper. Biol. & Med.50. 1942: 184
        • Sawyer W.H.
        Differences in the antidiuretic responses of rats to the intravenous administration of lysine and arginine vasopressins.
        Endocrinology. 1958; 63: 694
        • Berde B.
        • Cerletti A.
        Ueber die antidiuretische Wirkung von synthetischem Lysin-Vasopressin.
        Helvet. physiol. et pharmacol. acta. 1961; 19: 135
        • Berde B.
        • Saameli K.
        The action of the synthetic polypeptide valyl-oxytocin on the human uterus in vitro and in vivo.
        Acta endocrinol. 1959; 32: 391
        • Dekanski J.
        The quantitative assay of vasopressin.
        Brit. J. Pharmacol. 1952; 7: 567
      1. British Pharmacopeia. The Pharmaceutical Press, London1963
        • Schild H.O.
        A method of conducting a biological assay on a preparation giving repeated graded responses illustrated by the estimation of histamine.
        J. Physiol. 1942; 101: 115
        • Van Dyke H.B.
        • Adamsons Jr., K.
        • Engel S.L.
        Aspects of the biochemistry and physiology of the neurohypophyseal hormones.
        Recent Progr. Hormone Res. 1955; 11: 1
        • Holton P.
        A modification of the method of Dale and Laidlaw for standardization of posterior pituitary extract.
        Brit. J. Pharmacol. 1948; 3: 328
        • Gaddum J.H.
        • Peart W.S.
        • Vogt M.
        The estimation of adrenaline and allied substances in blood.
        J. Physiol. 1949; 108: 467
        • Coon J.M.
        A new method for the assay of posterior pituitary extracts.
        Arch. internat. pharmacodyn. 1939; 62: 79
        • Thompson R.E.
        Biological assay of posterior pituitary.
        J. Pharmacol. & Exper. Therap. 1944; 80: 373
      2. United States Pharmacopeia. Mack Printing Co, Easton, Pa1950 (14th Rev.)
        • Ames R.G.
        • Van Dyke H.B.
        Antidiuretic hormone in the serum or plasma of rats.
        Endocrinology. 1952; 50: 350
        • Vogt M.
        Vasopressor, antidiuretic and oxytocic activities of extracts of the dog's hypothalamus.
        Brit. J. Pharmacol. 1953; 8: 193
        • Acher R.
        • Light A.
        • du Vigneaud V.
        Purification of oxytocin and vasopressin by way of a protein complex.
        J. Biol. Chem. 1962; 233: 116
        • Hunter W.M.
        • Greenwood F.C.
        Preparation of iodine-131 labelled human growth hormone of high specific activity.
        Nature. 1962; 194: 495
        • Roth J.
        • Glick S.M.
        • Klein L.A.
        • Petersen M.J.
        Specific antibody to vasopressin in man.
        J. Clin. Endocrinol. 1966; 26: 671
        • Roth J.
        • Klein L.A.
        • Petersen M.J.
        Vasopressin antibodies and a sensitive radioimmunoassay.
        J. Clin. Invest. 1966; 45: 1064
        • Klein L.A.
        • Roth J.
        • Petersen M.J.
        Radioimmunoassay of arginine vasopressin (antidiuretic hormone).
        in: S. Forum. 17. 1966: 240
        • Lebacq E.
        • Delaere J.
        Origine des substances antidiuretiques et explication de l'hypernatriurie dans le syndrome de Schwartz-Bartter.
        Ann. endocrinol. 1965; 26: 375
        • Heller H.
        • Zaimis E.J.
        The antidiuretic and oxytocic hormones in the posterior pituitary glands of newborn infants and adults.
        J. Physiol. 1949; 109: 162
        • Barnafi L.
        • Croxatto H.
        The concentration of vasopressin and oxytocin in the human hypothalamo-hypophysial system.
        Experientia. 1963; 19: 489