Skip to main content
SpringerLink
Log in

Endocrine and Metabolic Symptoms of Cancer and Its Treatment

  • Chapter
  • First Online:
The MASCC Textbook of Cancer Supportive Care and Survivorship

  • 1033 Accesses

Abstract

Metabolic derangements and endocrine abnormalities, including paraneoplastic syndromes, are common complications of cancer or its treatment. Electrolyte abnormalities including hypernatremia and hyponatremia, hypercalcemia, hypomagnesemia, and hypoglycemia in cancer patients can result in a host of symptoms and even death if not detected and treated appropriately. Tumor lysis syndrome, a potentially life-threatening complication, can result from the treatment of cancer and result in acute renal failure and organ dysfunction. Endocrine abnormalities including tumor fever, SIADH resulting in hyponatremia, Cushing’s disease, hypothyroidism, and hypogonadism are not uncommon in cancer patients. Emerging targeted therapy, such as tyrosine kinase inhibitors, may be complicated by thyroid abnormalities which frequently result in nonspecific symptoms which may go undetected. Sweats and hot flashes are often noted in cancer patients and can impact quality of life. In order for healthcare providers to provide “best supportive care” for cancer patients, they need to be familiar with managing metabolic derangements and endocrine abnormalities which will be summarized in the following chapter.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Tosi P, Barosi G, Lazzaro C, et al. Consensus conference on the management of tumor lysis syndrome. Haematologica. 2008;93(12):1877–85.

    Article  PubMed  Google Scholar 

  2. Cairo MS, Bishop M. Tumor lysis syndrome: new therapeutic strategies and classification. Br J Haematol. 2004;127:3–11.

    Article  PubMed  Google Scholar 

  3. Coiffer B, Altman A, Pui C, Younes A, Cairo M. Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review. J Clin Oncol. 2008;26(16):2767–78.

    Article  Google Scholar 

  4. Cairo MS, Coiffier B, Reiter A, et al. Recommendation for the evaluation of risk and prophylaxis of tumour lysis syndrome (TLS) in adults and children with malignant diseases: an expert TLS panel consensus. Br J Haematol. 2010;149(4):578.

    Article  CAS  PubMed  Google Scholar 

  5. Rampello E, Ficia T, Malaguarnera M. The management of tumor lysis syndrome. Nat Clin Pract Oncol. 2006;3:438–47.

    Article  PubMed  Google Scholar 

  6. Merten GJ, Burgess WP, Gray LV, et al. Prevention of contrast-induced nephropathy with sodium bicarbonate: a randomized controlled trial. JAMA. 2004;291:2328–34.

    Article  CAS  PubMed  Google Scholar 

  7. DeConti RC, Calabresi P. Use of allopurinol for prevention and control of hyperuricemia in patients with neoplastic disease. N Engl J Med. 1966;274:481–6.

    Article  CAS  PubMed  Google Scholar 

  8. Pui CH. Rasburicase: a potent uricolytic agent. Expert Opin Pharmacother. 2002;3:433–42.

    Article  CAS  PubMed  Google Scholar 

  9. Bosly A, Sonet A, Pinkerton CR, et al. Rasburicase (recombinant urate oxidase) for the management of hyperuricemia in patients with cancer. Cancer. 2003;98:1048–54.

    Article  CAS  PubMed  Google Scholar 

  10. Cleary JF. Fever and sweats: including the immunocompromised hosts. In: Berger A, Portenoy RK, Weissman DE, editors. Principles and practice of supportive oncology. Philadelphia, PA: Lippincott-Raven; 1998. p. 119–31.

    Google Scholar 

  11. Dinarello CA, Bunn PA. Fever. Semin Oncol. 1997;24(3):288–98.

    CAS  PubMed  Google Scholar 

  12. Klastersky J, Paesmans M, Rubenstein EB, et al. The multinational association for supportive care in cancer risk index: a multinational scoring system for identifying low-risk febrile neutropenic cancer patients. J Clin Oncol. 2000;18(16):3038–51.

    Article  CAS  PubMed  Google Scholar 

  13. Chang JC. How to differentiate neoplastic fever from infectious fever in patients with cancer: usefulness of the naproxen test. Heart Lung. 1987;16:122–7.

    Article  CAS  PubMed  Google Scholar 

  14. Chang JC. Antipyretic effect of naproxen and corticosteroids on neoplastic fever. J Pain Symptom Manage. 1988;3:141–4.

    Article  CAS  PubMed  Google Scholar 

  15. Steele RW, Tanaka PT, Lara RP, et al. Evaluation of sponging and of oral antipyretic therapy to reduce fever. J Pediatr. 1970;77(5):824–9.

    Article  CAS  PubMed  Google Scholar 

  16. Quigley CS, Baines M. Descriptive epidemiology of sweating in a hospice population. J Palliat Care. 1997;13(1):22–6.

    CAS  PubMed  Google Scholar 

  17. Dalal S, Zhukovsky DS. Pathophysiology and management of hot flashes. J Support Oncol. 2006;4(7):315–20.

    PubMed  Google Scholar 

  18. Writing Group for the Women’s Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principle results from the Women’s Health Initiative Randomized Controlled Trial. JAMA. 2002;288(3):321–33.

    Article  Google Scholar 

  19. Li CI, Malone KE, Poster PL, et al. Relationship between long duration and different regimens of hormone therapy and risk of breast cancer. JAMA. 2003;289(24):3254–63.

    Article  CAS  PubMed  Google Scholar 

  20. Holmberg L, iversen OE, Rudenstam CM, et al. Increased risk of recurrence after hormone replacement therapy in breast cancer survivors. J Natl Cancer Inst. 2008;100(7):475–82.

    Article  CAS  PubMed  Google Scholar 

  21. Loprinizi CL, Michalak JC, Quella SK, et al. Megestrol acetate for the prevention of hot flashes. N Engl J Med. 1994;331(6):347–52.

    Article  Google Scholar 

  22. Quella SK, Loprinzi CL, Sloan JA, et al. Long term use of megestrol acetate by cancer survivors for the treatment of hot flashes. Cancer. 1998;82(9):1784–8.

    Article  CAS  PubMed  Google Scholar 

  23. L’Esperance S, Frenette S, Dionne A, et al. Pharmacological and non-hormonal treatment of hot flashes in breast cancer survivors: CEPO review and recommendations. Support Care Cancer. 2013;21:1461–74.

    Article  PubMed  Google Scholar 

  24. Taku Km Melby MK, Kronenberg F, et al. Extracted or synthesized soybean isoflavones reduce menopausal hot flash frequency and severity: systematic review and meta-analysis of randomized controlled trials. Menopause. 2012;19(7):776–90.

    Article  PubMed  Google Scholar 

  25. Ralston SH, Gallager SJ, Patel U, et al. Cancer associated hypercalcemia: morbidity and mortality: clinical experience in 126 treated patients. Ann Intern Med. 1990;112:499–504.

    Article  CAS  PubMed  Google Scholar 

  26. Stewart A. Hypercalcemia associated with cancer. NEJM. 2005;352(4):373–9.

    Article  CAS  PubMed  Google Scholar 

  27. Ladenson JH, Lewis JW, McDonald JM, et al. Relationship of free and total calcium in hypercalcemic conditions. J Clin Endocrinol Metab. 1978;48:393–7.

    Article  Google Scholar 

  28. Layman R, Olson K, Van Poznak C. Bisphosphonates for breast cancer. Hematol Oncol Clin North Am. 2007;21(2):341–67.

    Article  PubMed  Google Scholar 

  29. Woo SB, Hellstein JW, Kalmar JR. Systematic review: bisphosphonates and osteonecrosis of the jaws. Ann Intern Med. 2006;144(10):753–61.

    Article  CAS  PubMed  Google Scholar 

  30. Hu MI, Glezerman IG, Leboulleux S, et al. Denosumab for treatment of hyperkalemia of malignancy. J Clin Endocrinol Metab. 2014;99(9):3144–52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Klastersky J. Side effects of ifosfamide. Oncology. 2003;65(Suppl 2):7–10.

    Article  CAS  PubMed  Google Scholar 

  32. Salahudeen AK, Doshi SM, Shah P. The frequency, cost, and clinical outcomes of hypernatremia in patients hospitalized to a comprehensive cancer center. Support Care Cancer. 2013;21:1871–8.

    Article  PubMed  Google Scholar 

  33. Cao L, Prashant J, Sumoza D. Renal salt wasting in a patient with cisplatin-induced hyponatremia. Am J Clin Oncol. 2002;25:344–6.

    Article  PubMed  Google Scholar 

  34. Hammond IW, Ferguson JA, Kwong K, Muniz E, Delisle F. Hyponatremia and syndrome of inappropriate anti-diuretic hormone reported with the use of Vincristine: an over representation of Asians? Pharmacoepidemiol Drug Saf. 2002;11(3):229–34.

    Article  CAS  PubMed  Google Scholar 

  35. Lassen U, Osterlind K, Hansen M, et al. Long-term survival in small-cell lung cancer: post-treatment characteristics in patients surviving 5 to 18+ years: an analysis of 1,714 consecutive patients. J Clin Oncol. 1995;13(5):1215–20.

    Article  CAS  PubMed  Google Scholar 

  36. Ellison DH, Berl T. Clinical practice. The syndrome of inappropriate antidiuresis. N Engl J Med. 2007;356(20):2064–72.

    Article  CAS  PubMed  Google Scholar 

  37. Verbalis JG, Goldsmith SR, Greenberg A, et al. Hyponatremia treatment guidelines 2007: expert panel recommendations. Am J Med. 2007;120:S1–S21.

    Article  CAS  PubMed  Google Scholar 

  38. Yeong-Hau LH, Shapiro JI. Hyponatremia: clinical diagnosis and management. Am J Med. 2007;120:653–8.

    Article  Google Scholar 

  39. Vassal G, Rubie C, Kalifa C, et al. Hyponatremia and renal sodium wasting in patients receiving cisplatinum. Pediatr Hematol Oncol. 1987;4:337–44.

    Article  CAS  PubMed  Google Scholar 

  40. Soupart A, Decaux G. Therapeutic recommendations for management of severe hyponatremia: current concepts on pathogenesis and prevention of neurologic complications. Clin Nephrol. 1996;46:149–69.

    CAS  PubMed  Google Scholar 

  41. Rabinstein AA, Wijdicks EF. Hyponatremia in critically ill neurological patients. Neurologist. 2003;9(6):290–300.

    Article  PubMed  Google Scholar 

  42. Laureno R. Central pontine myelinolysis following rapid correction of hyponatremia. Ann Neurol. 1983;13:232–42.

    Article  CAS  PubMed  Google Scholar 

  43. Palm C, Reimann D, Gross P. The role of V2 vasopressin antagonists in hyponatremia. Cardiovasc Res. 2001;51:403–8.

    Article  CAS  PubMed  Google Scholar 

  44. Wolf FL, Maier JA, Nasulewics A, et al. Magnesium and neoplasia : from carcinogenesis to tumor growth and progression or treatment. Arch Biochem Biophys. 2007;458:24–32.

    Article  CAS  PubMed  Google Scholar 

  45. Saif MW. Management of hypomagnesemia in cancer patients receiving chemotherapy. J Support Oncol. 2008;6:243–8.

    PubMed  Google Scholar 

  46. Mouw DR, Latessa RA, Hickner J. Clinical inquiries. What are the causes of hypomagnesemia? J Fam Pract. 2005;54:174–6.

    PubMed  Google Scholar 

  47. Neary NM, Booker OJ, Abel BS, et al. Hypercortisolism is associated with increased coronary arterial atherosclerosis: analysis of noninvasive coronary angiography using multidetector computerized tomography. J Clin Encocrinol Metab. 2013;98(5):2045–52.

    Article  CAS  Google Scholar 

  48. Nieman LK, Biller BM, Findling JW, et al. The diagnosis of Cushing’s syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2008;93:1526–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Blake MA, Kalra MK, Seeney AT, et al. Distinguishing benign from malignant adrenal masses: multi-detector row CT protocol with 10-minute delay. Radiology. 2006;238:578–85.

    Article  PubMed  Google Scholar 

  50. Oldfield EH, Chrousos GP, Schulte HM, et al. Preoperative lateralization of ACTH-secreting pituitary microadenomas by bilateral and simultaneous inferior petrosal venous sinus sampling. N Engl J Med. 1985;312:100–3.

    Article  CAS  PubMed  Google Scholar 

  51. Nieman LK, Biller BMK, Findling JW, et al. Treatment of Cushing’s syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2015;100(8):2807–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Luton JP, Cerdas S, Billaud L, et al. Clinical features of adrenocortical carcinoma, prognostic factors, and the effect of mitotane therapy. N Engl J Med. 1990;322:1195–201.

    Article  CAS  PubMed  Google Scholar 

  53. Nayar MK, Lombard MG, Furlong NJ, et al. Diagnosis and management of nonislet cell tumor hypoglycaemia. Endocrinologist. 2006;16(4):227–30.

    Article  Google Scholar 

  54. Service FJ. Hypoglycemic disorders. N Engl J Med. 1995;332(17):1144–52.

    Article  CAS  PubMed  Google Scholar 

  55. de Groot JW, Rikhof B, van Doorn J, et al. Non-islet cell tumour induced hypoglycaemia: a review of the literature including two new cases. Endocr Relat Cancer. 2007;14:979–93.

    Article  PubMed  Google Scholar 

  56. Le Roith D. Tumor-induced hypoglycemia. N Engl J Med. 1999;341:757–8.

    Article  PubMed  Google Scholar 

  57. Daughaday WH, Trivedi B. Measurement of derivatives of proinsulin-like growth factor-II in serum by radioimmunoassay directed against the E-domain in normal subjects and patients with nonislet cell tumor hypoglycemia. J Clin Endocrinol Metab. 1992;75:110–5.

    CAS  PubMed  Google Scholar 

  58. McDermott MT. In the clinic. Hypothyroidism. Ann Intern Med. 2009;151(11):ITC61.

    PubMed  Google Scholar 

  59. Carter Y, Sippel RS, Chen H. Hypothyroidism after a cancer diagnosis: etiology, diagnosis, complications, and management. Oncologist. 2014;19:34–43.

    Article  CAS  PubMed  Google Scholar 

  60. Boomsma MJ, Bijl HP, Langendijk JA. Radiation-induced hypothyroidism in head and neck cancer patients: a systematic review. Radiother Oncol. 2011;99:1–5.

    Article  CAS  PubMed  Google Scholar 

  61. Garcia-Serra A, Amdur RJ, Morris CG, et al. Thyroid function should be monitored following radiotherapy to the low neck. Am J Clin Oncol. 2005;28:255–8.

    Article  PubMed  Google Scholar 

  62. Del Fabbro E, Dev R, Cabanillas ME, et al. Extreme hypothyroidism associated with sunitinib treatment for metastatic renal cancer. J Chemother. 2012;24:221–5.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Rose SR. Cranial irradiation and central hypothyroidism. Trends Endocrinol Metab. 2001;12:97–104.

    Article  CAS  PubMed  Google Scholar 

  64. Byun DJ, Wolchok JD, Roseberg LM, Girotra M. Cancer immunotherapy – immune checkpoint blockade and associated endocrinopathies. Nat Rev Endocrinol. 2017;13(4):195–207.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Zitzmann M, Nieschlag E. Hormone substitution in male hypogonadism. Mol Cell Endocronol. 2000;161:73–88.

    Article  CAS  Google Scholar 

  66. Seftel AD, Kathrins M, Niederberger C. Critical update of the 2010 endocrine society clinical practice guidelines for male hypogonadism: a systematic analysis. Mayo Clin Proc. 2015;90:1104–15.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Symptom Control and Palliative Medicine, Houston, TX, USA

    Rony Dev

Authors
  1. Rony Dev
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rony Dev .

Editor information

Editors and Affiliations

  1. University of South Australia, Adelaide, SA, Australia

    Ian Olver

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Dev, R. (2018). Endocrine and Metabolic Symptoms of Cancer and Its Treatment. In: Olver, I. (eds) The MASCC Textbook of Cancer Supportive Care and Survivorship. Springer, Cham. https://doi.org/10.1007/978-3-319-90990-5_15

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-90990-5_15

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-90989-9

  • Online ISBN: 978-3-319-90990-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation