University of Texas, M.D. Anderson Cancer Center Houston, Texas 77030-4095
To the editor:
The work by Sarlis et al. (1) confirms that paraneoplastic hypercortisolism constitutes a risk factor for severe bacterial and opportunistic infections even when patients with small cell lung cancer (SCLC) are excluded. They suggest that inclusion of SCLC cases, as in our earlier paper (2), cloud the question because "these patients have tumor-related features that could confound the association." Indeed, patients with carcinoid or other neuroendocrine tumors are clinically different from patients with SCLC, and both groups are at increased risk.
I would like to emphasize two clinical points about these patients:
At our institution, patients with paraneoplastic hypercortisolism begin metyrapone promptly, whether the treatment plan includes cytotoxic chemotherapy, surgery, or conservative surveillance; this provides the patients with gratifying clinical improvement and decreases complications. When cytotoxic chemotherapy seems to be an urgent priority (as in most patients with SCLC), our colleagues in medical oncology try to avoid myelosuppressive regimens until cortisol has been normalized for a few weeks.
Received January 21, 2000.
References
HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Endocrinology | Endocrine Reviews | J. Clin. End. & Metab. |
Molecular Endocrinology | Recent Prog. Horm. Res. | All Endocrine Journals |