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Metabolische Entgleisungen als paraneoplastische Syndrome

Metabolic disorders as paraneoplastic syndromes

  • Schwerpunkt: Paraneoplastische Syndrome
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Zusammenfassung

Paraneoplastische Syndrome sind charakterisiert durch die tumorinduzierte Freisetzung von Peptidhormonen und/oder die Induktion von Immunphänomenen, die von der Tumormasse völlig unabhängige klinische und laborchemische Veränderungen hervorrufen. Neben neurologischen, endokrinen und rheumatologischen Erscheinungsformen spielen im klinischen Alltag metabolische Veränderungen eine besondere Rolle, die aufgrund ihrer oftmals akuten Symptomatik medizinische Notfälle darstellen und einer zügigen Diagnosestellung und prompten Therapieeinleitung bedürfen. Metabolische Veränderungen im Rahmen von malignen Erkrankungen sollen in einem interdisziplinären Team behandelt werden, oftmals ist hierzu auch ein intensivmedizinisches Monitoring nötig. Im Folgenden werden Diagnostik und Therapiemöglichkeiten paraneoplastisch bedingter metabolischer Entgleisungen dargestellt. Beispiele sind Hyperkalzämie, Hypokalzämie, Hyperglykämie und Hypoglykämie sowie als Sonderform tumorassoziierte metabolische Entgleisungen durch das Tumorlysesyndrom.

Abstract

Paraneoplastic syndromes are characterized by the tumor-induced release of peptide hormones and/or the initiation of immune phenomena, which elicit clinical changes and alterations in laboratory parameters independent of the tumor size and spread. In addition to neurological, endocrinal and rheumatological phenotypes, metabolic alterations play a special role in the clinical routine as they commonly present with acute symptoms in an emergency situation and necessitate immediate diagnosis and prompt initiation of treatment. Metabolic alterations within the framework of malignant diseases should be treated in a multidisciplinary team and it is often necessary to perform monitoring and treatment in an intensive care unit. This article focuses on the diagnostic and therapeutic options for metabolic disorders due to paraneoplastic syndromes, such as hypercalcemia, hypocalcemia, hyperglycemia, hypoglycemia and a special variant of tumor-induced metabolic disorders due to tumor lysis syndrome.

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  1. Klinik für Innere Medizin I, Martin-Luther-Universität Halle/Wittenberg, Ernst-Grube-Str. 40, 06114, Halle (Saale), Deutschland

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Krug, S., Michl, P. Metabolische Entgleisungen als paraneoplastische Syndrome. Internist 59, 114–124 (2018). https://doi.org/10.1007/s00108-017-0357-2

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