A 62-year-old man undergoing evaluation of an incidentally detected right renal mass has elevated serum alkaline phosphatase, prolonged prothrombin time and raised alpha-fetoprotein, but liver imaging shows no metastases and no cirrhosis. These abnormalities resolve completely after removal of the tumour. What is this entity called?

• A Stauffer syndrome ✓
• B Carcinoid syndrome
• C Lambert-Eaton syndrome
• D Trousseau syndrome

Explanation

Stauffer syndrome is the non-metastatic hepatic dysfunction associated with renal cell carcinoma, characterised by elevated alkaline phosphatase, prolonged prothrombin time, raised alpha-fetoprotein and sometimes hepatosplenomegaly, all reversible after nephrectomy since it is mediated by tumour cytokines such as IL-6. Carcinoid syndrome arises from serotonin-secreting neuroendocrine tumours, Lambert-Eaton is a paraneoplastic neuromuscular syndrome of small cell lung cancer, and Trousseau syndrome is migratory thrombophlebitis with visceral malignancy.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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