The pleura and the endocrine system

Published:January 13, 2020DOI:


      • Both hypothyroidism and thyrotoxicosis may induce a pleural effusion.
      • Thoracic endometriosis can cause catamenial pneumothorax or hemothorax.
      • Surgery and hormone therapy are recommended in recurrent catamenial pneumothorax.
      • Pleural effusion due to hormone-sensitive cancer may improve with endocrine treatment.
      • Solitary fibrous tumor of pleura can affect different endocrine functions.


      The functioning of the pleura and the endocrine system are not entirely independent of each other. Some hormones can reach a greater concentration in the pleural exudate than in the blood. However, the clinical significance of this finding remains unknown. In some circumstances, hormonal changes are responsible for pathological manifestations in the pleura. Hypothyroidism is one of the most common diseases that can cause a pleural effusion, likely resulting from alterations in capillary permeability. The presence of ectopic endometrial tissue within the lung parenchyma, pleura, pericardium or diaphragm is known as thoracic endometriosis and is one of the causes of catamenial pneumothorax and /or catamenial hemothorax, which can affect women of childbearing age and arises within 72 h from the onset of menstruation. Treatment and prevention of recurrent catamenial pneumothorax / hemothorax usually requires an approach that combines surgery and hormone therapy. Malignant pleural effusion from breast cancer may contain estrogen receptor-positive cells. In such a case, endocrine treatment may be effective in reducing the amount of pleural fluid and the associated symptoms. Thyroid cancer and lymphangioleiomyomatosis (LAM) are further hormone-sensitive malignancies in which pleura is frequently involved. The solitary fibrous tumor of pleura (SFPT) is an example of a pleural disease that can cause hormonal balance disorders. It can lead to a rise in the releasing factor for growth hormone (GHRH), human beta chorionic gonadotropin (Beta-hCG), and insulin-like growth factor 2 (IGF2). The consequence of such hormonal imbalance include hypertrophic pulmonary osteoarthropathy, gynecomastia, and refractory hypoglycemia, respectively.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to European Journal of Internal Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kleine B
        • Rossmanith WG.
        Hormones and the endocrine system.
        Springer International Publishing, 2016
        • Milla CE
        • Zirbes J.
        Pulmonary complications of endocrine and metabolic disorders.
        Paediatr Resp Rev. 2012; 13: 23-28
        • Lencu C
        • Alexescu T
        • Petrulea M
        • Lencu M
        Respiratory manifestations in endocrine diseases.
        Clujul Med. 2016; 89: 459-463
        • Rovensky J
        • Simorova E
        • Radikova Z
        • et al.
        Comparison of hormone transfer to pleural and synovial exudates.
        Endocr Regul. 2006; 40: 29-36
        • Parasar P
        • Ozcan P
        • Terry KL
        Endometriosis: Epidemiology, Diagnosis and Clinical Management.
        Curr Obstet Gynecol Rep. 2017; 6: 34-41
        • Laganà AS
        • Vitale SG
        • Salmeri FM
        • Triolo O
        • Ban Frangež H
        • Vrtacˇnik-Bokal E
        • et al.
        Unus pro omnibus, omnes pro uno: a novel, evidence-based, unifying theory for the pathogenesis of endometriosis.
        Med Hypotheses. 2017; 103: 10-20
        • Alwadhi S
        • Kohli S
        • Chaudhary B
        • Gehlot K
        Thoracic endometriosis—a rare cause of haemoptysis.
        J Clin Diagn Res. 2016; 10 (TD1–2)
        • Hagnere P
        • Deswarte S
        • Leleu O
        Thoracic endometriosis: a difficult diagnosis.
        Rev Mal Respir. 2011; 28: 908-912
        • Nair SS
        • Nayar J.
        Thoracic endometriosis syndrome: a veritable pandora's box.
        J Clin Diagn Res. 2016; 10 (QR04-8)
        • Bobbio A
        • et al.
        Thoracic endometriosis syndrome other than pneumothorax: clinical and pathological findings.
        Ann Thorac Surg. 2017; 104: 1865-1871
        • Visouli A
        Catamenial pneumothorax.
        J Thorac Dis. 2014; 6: 448-460
        • Rousset-Jablonski C
        Catamenial pneumothorax and endometriosis related pneumothorax:clinical features and risk factors.
        Hum Reprod. 2011; 26: 2322-2329
        • Narula N.
        • Ngu S.
        • Avula A.
        • et al.
        Left-sided catamenial pneumothorax: a rare clinical entity.
        Cureus. 2018; 10: e2567
        • Leong A.C
        • Coonar A.S
        • Lang-Lazdunski L.
        Catamenial pneumothorax: surgical repair of the diaphragm and hormone treatment.
        Ann R Coll Surg Engl. 2006; 88: 547-549
        • Kirschner P
        Porous diaphragm syndromes.
        Chest Surg Clin N Am. 1998; 8: 449e472
        • MacDuff A
        • Arnold A
        • Harvey J
        Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010.
        Thorax. 2010; 65: ii18-ii31
        • Haddad R
        • Arévalo C
        • Nigri D
        Catamenial pneumothorax: presentation of an uncommon pathology: review of topic.
        Clin Surg. 2017; 2: 1801
        • Ghigna MR
        • Mercier O
        • Mussot S
        • Fabre D
        • Fadel E
        • Dorfmuller P
        • et al.
        Thoracic endometriosis: clinicopathologic updates and issues about 18 cases from a tertiary referring center.
        Ann Diagn Pathol. 2015; 19: 320-325
        • Garner M
        • Ahmed E
        • Gatiss S
        • West D
        Hormonal manipulation after surgery for catamenial pneumothorax.
        Interact Cardiovasc Thorac Surg. 2018; 26: 319-322
        • Suardika A
        • Astawa Pemayun TG
        New insights on the pathogenesis of endometriosis and novel non-surgical therapies.
        J Turk Ger Gynecol Assoc. 2018; 19 (6): 158-164
        • Hwang SM
        • Lee CW
        • Lee BS
        • Park JH
        Clinical features of thoracic endometriosis: a single centre analysis.
        Obstet Gynecol Sci. 2015; 58: 223-231
        • Marshall MB
        • Ahmed Z
        • Kucharczuk JC
        • et al.
        Catamenial pneumothorax: optimal hormonal and surgical management.
        Eur J Cardiothorac Surg. 2005; 27: 662-666
        • Zimmerman L.
        Pulmonary complications of endocrine diseases.
        in: Broaddus VC Mason RJ Ernst JD King TE Lazarus SC Murray JF Murray and Nadel’s. Textbook of respiratory medicine. 6th ed. Elsevier Saunders, Philadelphia2016: 1671-1678 (chapter 95)
        • Gottehrer A
        • Roa J
        • Stanford GS
        • Chernow B
        • Sahn SA
        Hypothyroidism and pleural effusions.
        Chest. 1990; 98: 1130-1132
        • Kumar G
        • Kumar A
        • Bundela RP
        • et al.
        Hypothyroidism presenting as multiple body cavity effusions.
        J Assoc Physicians India. 2016; 64: 83-84
        • Brüssel T
        • Matthay MA
        • Chernow B
        Pulmonary manifestations of endocrine and metabolic disorders.
        Clin Chest Med. 1989; 10: 645-653
        • Lencu C
        • Alexescu T
        • Petrulea M
        • Lencu M
        Respiratory manifestations in endocrine diseases.
        Clujul Medical. 2016; 89: 459-463
        • Kinoshita H
        • Yasuda M
        • Kaneko S
        • et al.
        Thyroid hormones, their carrier proteins, and thyroid antibodies in the pleural effusion of two patients with graves' disease-induced thyrotoxicosis.
        Endocr Res. 2010; 35: 183-187
        • Apffelstaedt JP
        • Van Zyl JA
        • Muller AG
        Breast cancer complicated by pleural effusion: patient characteristics and results of surgical management.
        J Surg Oncol. 1995; 58: 173-175
        • Aydogmus U
        • Ozdemir S
        • Cansever L
        • et al.
        Bedside talc pleurodesis for malignant pleural effusion; factors affecting success.
        Ann Surg Oncol. 2009; 16: 745-750
        • Feller-Kopman DJ
        • Reddy CB
        • DeCamp MM
        • et al.
        Management of malignant pleural effusions. An Official ATS/STS/STR clinical practice guideline.
        Am J Respir Crit Care Med. 2018; 198: 839-849
        • Lee SY
        • Seo JH.
        Current strategies of endocrine therapy in elderly patients with breast cancer.
        Biomed Res Int. 2018; 6074808
        • Shinohara T
        • Yamada H
        • Fujimori Y
        • Yamagishi K
        Malignant pleural effusion in breast cancer 12 years after mastectomy that was successfully treated with endocrine therapy.
        Am J Case Rep. 2013; 14: 184-187
        • Noda K
        • Murase K
        • Otaki Y
        • Yasuda J
        Pleural metastasis of thyroid carcinoma diagnosed by thoracoscopy under local anesthesia.
        Respirol Case Rep. 2014; 2: 51-53
        • Rosenstengel A
        • Lim EM
        • Millward M
        • et al.
        A distinctive color associated with high iodine content in malignant pleural effusion from metastatic papillary thyroid cancer: a case report.
        J. Med. Case Rep. 2013; 7: 147
        • McCormack FX
        Lymphangioleiomyomatosis: a clinical update.
        Chest. 2008; 133: 507-516
        • Prizant H.
        • Minireview H.S.R.
        Lymphangioleiomyomatosis (LAM): the “Other” steroid-sensitive cancer.
        Endocrinology. 2016; 157: 3374-3383
        • Agarwal VK
        • Plotkin BE
        • Dumani D
        • et al.
        Solitary fibrous tumor of pleura: a case report and review of clinical, radiographic and histologic findings.
        J Radiol Case Rep. 2009; 3: 16-20
        • Hiraoka K
        • Morikawa T
        • Ohbuchi T
        • et al.
        Solitary fibrous tumors of the pleura: clinicopathological and immunohistochemical examination.
        Interact Cardiovasc Thorac Surg. 2003; 2: 61-64
        • Karki A
        • Yang J
        • Chauhan S
        Paraneoplastic syndrome associate with solitary fibrous tumor of pleura.
        Lung India. 2018; 35: 245-247
        • Han G.
        • Zhang Z.
        • Shen X.
        • et al.
        Doege–Potter syndrome. A review of the literature including a new case report.
        Medicine. 2017; 96: e7417
        • Perrotta F
        • Cerqua FS
        • Cammarata A
        • et al.
        Integrated therapeutic approach to Giant Solitary Fibrous Tumor of the Pleura: report of a case and review of the literature.
        Open Med. 2016; 11: 220-225
        • Mazzella A
        • Izzo A
        • Amore D
        • et al.
        Single port VATS resection of a sessile solitary fibrous tumour of the visceral pleura. A case report.
        Ann Ital Chir. 2015; 86 (ePub)
        • Practice Committee of the American Society for Reproductive Medicine
        Treatment of pelvic pain associated with endometriosis.
        Fertil Steril. 2008; 90: S260-S269