Carcinoid encephalopathy: A single entity or a spectrum of different disorders?

Lapeire, Lore; Tansens, Anneleen; Lemmens, Gilbert; Belle, Simon J. van

doi:10.3109/02841860903413640

Cited by 3 publications

(2 citation statements)

References 8 publications

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“…Associated neurological disorders include carcinoid myopathy and carcinoid encephalopathy. Other mechanisms of carcinoid encephalopathy have also been proposed such as excessive production of serotonin in the brain by CNS metastasis, fulminant hepatic metastasis and aberrant secretion of ACTH of CRH by carcinoid tumours (Lapeire et al, 2010). Treatment of carcinoid encephalopathy is mainly focused on controlling the tumour although more 'targeted' treatment such as oral tryptophan substitution or serotonin receptor antagonism have proved their use in case reports.…”

Section: Non-immune Mediated Paraneoplastic Encephalopathiesmentioning

confidence: 99%

Neoplasm Related Encephalopathies

Lapeire¹,

Sieben²,

Santens³

et al. 2012

Miscellanea on Encephalopathies - A Second Look

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Section: Non-immune Mediated Paraneoplastic Encephalopathiesmentioning

confidence: 99%

Neoplasm Related Encephalopathies

Lapeire¹,

Sieben²,

Santens³

et al. 2012

Miscellanea on Encephalopathies - A Second Look

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“…Even though paraneoplastic manifestations of malignant tumour and brain metastatic manifestations can occur in carcinoid patients [1, 2], encephalopathy due to tryptophan deficiency is extremely rare, thus diagnosis of tryptophan deficiency encephalopathy could be easily missed. In carcinoid syndrome with large tumor, there is a 70 fold increase in the utilization of tryptophan, which can cause deficiency over a period of time.…”

mentioning

confidence: 99%

Carcinoid-associated Encephalopathy

Femminella¹,

Kenny

Sinha

et al. 2015

Journal of Clinical Gastroenterology

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Here we present an unusual case of acute encephalopathy which could have been potentially prevented by simple supplementation of tryptophan in a patient with large metastatic carcinoid tumor in the liver.An 80-year-old man presented to the Acute and Emergency Department with pyrexia (40 C degrees) and right upper abdominal pain radiating to back. Five days before he had undergone radiofrequency ablation (RFA) of 8cm liver lesion secondary to a neuroendocrine carcinoid, but multiple smaller liver lesions were also present. On admission he reported pain over the access site for RFA since the procedure and was associated with nausea and general malaise. However, there was an improvement in symptoms of diarrhoea since RFA. Clinical examination demonstrated that the patient was hypotensive, tachycardic and tachypnoic, with a normal abdominal examination. His initial blood results showed elevated CRP levels, leucopoenia and anaemia. To rule out a post-RFA intrahepatic collection, an abdominal CT scan was performed, showing normal post-RFA changes and the patient was started on antibiotics, due to the initial impression of post-procedural sepsis. The blood cultures were positive for E. coli and the patient was started on Ertapenem and Metronidazole. He improved after five days and was afebrile, with reduced CRP levels. After 10 days, the patient started becoming confused and drowsy with clinical features of encephalopathy. However, there was no evidence of ongoing sepsis and blood cultures were negative, thus a brain MRI scan and an electroencephalogram (EEG) were performed. The EEG showed a diffuse mixture of theta and delta activities at 1.75-6.5Hz with absent alpha rhythm compatible with metabolic encephalopathy, while the MRI findings were essentially normal. Due to increased confusion and reduced GCS (GCS=9/15), a lumbar puncture was performed, showing no signs of encephalitis. Initially a diagnosis of paraneoplastic neurological syndrome was considered, which is described in patients with carcinoid. However Anti-Yo, Anti-Hu, Anti-Ri, Anti-Voltage gated K Channel, Anti-Glutamic Acid decarboxylase, Anti-NMDA Receptor antibodies were negative. Due to ongoing confusion and without any evidence of sepsis, a diagnosis of metabolic encephalopathy was made,

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PTU-160 Successful clearance of chronic noroviral infection by ribavirin in a patient with common variable immunodeficiency-associated enteropathy results in complete symptomatic and histopathological resolution

Woodward¹,

Aravinthan

et al. 2012

Gut

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Carcinoid encephalopathy: A single entity or a spectrum of different disorders?

Cited by 3 publications

References 8 publications

Neoplasm Related Encephalopathies

Neoplasm Related Encephalopathies

Carcinoid-associated Encephalopathy

PTU-160 Successful clearance of chronic noroviral infection by ribavirin in a patient with common variable immunodeficiency-associated enteropathy results in complete symptomatic and histopathological resolution

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