<prompt> ACTH is produced by which carcinoma?Adenocarcinoma LungSmall cell cancer LungSquamous cell carcinoma of lungBronchoaveolar carcinoma Lung  <response>: ANSWER: B Small cell cancer LungREF: Harrisons 18th ed Table 96-1, Principles and Practice of Endocrinology and Metabolism 3rd ed Page 957However all varieties of lung cancer can produce ACTH, the most common and hence the most appropriate answer is Small cell lung cancerTwo-thirds of the cases of paraneoplastic ACTH syndrome are attributable to bronchogenic cancer. The principal offender is small cell cancer of the lungSmall cell lung cncer 50 is by far the most common cause of ectopic ACTH, followed by thymic carcinoid 15, islet cell tumors 10, bronchial carcinoid 10, other carcinoids 5, and pheochromocytomas 2Paraneoplastic Syndromes Caused by Ectopic Hormone ProductionParaneoplastic syndrome CommonEctopic HormoneTypical Tumor TypesHypercalcemia of malignancyParathyroid hormone-related protein PTHrP1,25 dihydroxyvitamin DParathyroid hormone PTH rare Prostaglandin E2 PGE2rareSquamous cell head and neck, lung, skin,breast, genitourinary, gastrointestinalLymphomasLung, ovaryRenal, lungSyndrome of inappropriate antidiuretic hormonesecretion SLADHVasopressinLung squamous, small cell, gastrointestinal, genitourinary, ovaryCushings syndromeAdrenocorticotropic hormone ACTHLung small cell, bronchial carcinoid, adenocarcinoma, squamous, thymus, pancreatic islet , medullary thyroid carcinoma Corticotropin-releasing hormone CRH rareEctopic expression of gastric inhibitory peptide GIP, luteinizing hormone LH human chorionic gonadotropin hCG, other G protein-coupled receptors rarePancreatic islet, carcinoid, lung, prostateMacronodular adrenal hyperplasiaLess Common Non-islet cell hypoglycemiaInsulin-like growth factor 1GF-IIMesenchymal tumors, sarcomas, adrenal, hepatic, gastrointestinal, kidney, prostate Insulin rareCervix small cell carcinomaMale feminizationhCGTestis embryonal, seminomas, germinomas, choriocarcinoma, lung, hepatic, pancreatic isletDiarrhea or intestinal hypermotilityCalcitonin1Lung, colon, breast, medullary thyroid carcinoma Vasoactive intestinal peptide VIPPancreas, pheochromocytoma, esophagusRare Oncogenic osteomalaciaPhosphatonin fibroblast growth factor 23 FGF23IHemangiopericytomas, osteoblastomas, fibromas, sarcomas, giant cell tumors, prostate, lungAcromegalyGrowth hormone-releasing hormone GHRHGrowth hormone GHPancreatic islet, bronchial and other carcinoidsLung, pancreatic isletHyperthyroidismThyroid-stimulating hormone TSHHydatidiform mole, embryonal tumors, struma ovariiHypertensionReninJuxtaglomerula tumors, kidney, lung, pancreas, ovaryNOTE:Some important points about lung cancer which must be remembered:Most common variety in worldwideMost common variety in non smokersMost common variety in young patientsMost common variety in femalesArising from scars of lung tissueAdenocarcinomaCancer lung which metastases to opposite side lung to lung metastasisBronchoalveolar variant of adenocarcinomaMost common variant in IndiaLung cancer which cavitatesCentral location Best prognosisMost common variety of lung ca associated with hypercalcemiaAssociated with Nickel, Chromium, Ether, Mustard gasSquamous cell carcinomaMost common variety associated with paraneoplastic syndromeMost common variety in smokersMost aggressive variantAssociated with HypokalemiaWorst prognosisBest response to chemotherapyBest response to radiotherapyAssociated BL hilar hymphadenopathyCentral locationOccupational risk of UraniumSmall cell carcinoma 