Abstract
Hypotension can be a symptom of paraneoplastic autonomic neuropathy (PAN). Onconeural antibodies (OA) provide strong evidence for the paraneoplastic origin of neurological syndromes. Our goal was to assess the frequency of PAN among patients with advanced malignancies and hypotension using OA. Patients with advanced malignancies and hypotension were screened and enrolled as per protocol. Plasma levels of six classical OAs were assessed in these patients. We prospectively evaluated other symptoms of PAN in these patients. 31 patients out of 740 screened met the criteria of this cross-sectional study. OAs were present in 4 patients (12.9%). Anti-amphiphysin was found in 1 patient (3.23%), anti- CV2 (anti-CRPM5, anti- collapsin- response mediator protein) was present in 1 patient (3.23%), 1 patient (3.23%) was positive for anti-Hu and anti-Ma2 was present in 1 patient (3.23%). No patient was positive for 2 or more OAs. Normalization of blood pressure in concordance with partial remission occurred in 5 patients. The most used criteria for PAN were fulfilled in 9 patients. The frequency of PAN may be underestimated in a busy oncology clinic. Assessing OAs may aid in the differential diagnosis of hypotension of unknown origin.
Highlights
Hypotension can be a frequent sign in patients with advanced malignancies but the etiology varies and may include low fluid intake and dehydration, advanced tumour kachexia, compression or damage to the organs of the cardiovascular system
Anti-amphiphysin was present in 1 patient (3.23%), anti-CV2 was present in 1 patient (3.23%), 1 patient (3.23%) was positive for antiHu and anti-Ma2 was present in 1 patient (3.23%)
Paraneoplastic autonomic neuropathy (PAN) is rare paraneoplastic syndrome that can be common to various malignancies
Summary
Hypotension can be a frequent sign in patients with advanced malignancies but the etiology varies and may include low fluid intake and dehydration, advanced tumour kachexia, compression or damage to the organs of the cardiovascular system. Deposits of amyloid can be associated with hypotension in patients with plasma cell malignancies. Paraneoplastic autonomic neuropathy (PAN) is a rare paraneoplastic syndrome that can occur in patients with various malignancies. Most frequently, it is found in patients with small- cell lung cancer (SCLC) and thymomas. Hypotension is the most frequent symptom Onconeural antibodies are produced by tumours and damage the autonomic nervous system. Neal et al.[1] presented the case of a patient with advanced SCLC who experienced repetitive collapses caused by orthostatic hypotension as the only symptom of PAN. Positivity of collapse- response mediator protein 5 (CRMP5) was detected in this patient
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