Differential Diagnosis of Diarrhea in Patients With Neuroendocrine Tumors

Eads, Jennifer R.; Reidy‐Lagunes, Diane; Soares, Heloisa P.; Chan, Jennifer A.; Anthony, Lowell; Halfdanarson, Thorvardur R.; Naraev, Boris G.; Wolin, Edward M.; Halperin, Daniel M.; Li, Daneng; Pommier, Rodney F.; Zacks, Jerome; Morse, Michael A.; Metz, David C.

doi:10.1097/mpa.0000000000001658

Cited by 12 publications

(7 citation statements)

References 42 publications

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“…Also, patients with an established CS, on treatment, can experience deterioration of their symptoms from other causes. 27,28 • Diarrhoea in CS is always secretory, persists with fasting, may occur during the night and is associated with abdominal discomfort and faecal urgency. Sometimes, to prove "secretory" diarrhoea, an estimation of faecal fluid "osmotic gap" is needed, with an "osmotic gap" of A short bowel syndrome, defined as a length of functional small bowel < 200 cm may occur after extensive intestinal resection.…”

Section: Q2: What Is the Differential Diagnosis Of Cs?mentioning

confidence: 99%

“…The most common symptoms in CS (flushing, diarrhoea, their combination) may represent manifestations of other clinical entities. Also, patients with an established CS, on treatment, can experience deterioration of their symptoms from other causes 27,28 Diarrhoea in CS is always secretory, persists with fasting, may occur during the night and is associated with abdominal discomfort and faecal urgency. Sometimes, to prove “secretory” diarrhoea, an estimation of faecal fluid “osmotic gap” is needed, with an “osmotic gap” of < 50 mOsm kg –1 being diagnostic for secretory diarrhoea.…”

Section: B Diagnosismentioning

confidence: 99%

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European Neuroendocrine Tumor Society (ENETS) 2022 Guidance Paper for Carcinoid Syndrome and Carcinoid Heart Disease

Glasberg

Davar

Hofland

et al. 2022

J Neuroendocrinology

125

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Data regarding the diagnosis, management, and follow-up of carcinoid syndrome (CS) and carcinoid heart disease (CHD) were identified by searches of the MEDLINE database using specific terms in human studies: CS; CHD; screening; epidemiology; diagnosis; treatment; prognosis. The search results were supplemented by manual searching of relevant journals, reference lists in key articles and other appropriate documents, and expert opinion. All recommendations are offered on the basis of the best available evidence, supplemented by the authors' experiences in managing CS and CHD. Each recommendation for treatment will have a level of evidence and grade of recommendation as per the GRADE system (adapted in Infectious Disease society This first ENETS guidance paper on CS aims to provide practical guidance for NEN specialists in the diagnosis and management of CS, with special emphasis on CHD.

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Section: Q2: What Is the Differential Diagnosis Of Cs?mentioning

confidence: 99%

Section: B Diagnosismentioning

confidence: 99%

European Neuroendocrine Tumor Society (ENETS) 2022 Guidance Paper for Carcinoid Syndrome and Carcinoid Heart Disease

Glasberg

Davar

Hofland

et al. 2022

J Neuroendocrinology

125

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“…Serotonin is considered the key mediator of diarrhoea. It should be noted that carcinoid syndrome is not the only possible cause of diarrhoea in patients with NENs, and appropriate diagnosis is always indicated [19,20].…”

Section: Laboratory Diagnosticsmentioning

confidence: 99%

Neuroendocrine neoplasms of the small intestine and the appendix — update of the diagnostic and therapeutic guidelines (recommended by the Polish Network of Neuroendocrine Tumours) [Nowotwory neuroendokrynne jelita cienkiego i wyrostka robaczkowego — uaktualnione zasady diagnostyki i leczenia (rekomendowane przez Polską Sieć Guzów Neuroendokrynnych)]

Bednarczuk

Zemczak²,

Bolanowski³

et al. 2022

Endokrynol Pol

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Updated Polish recommendations for the management of patients with neuroendocrine neoplasms (NENs) of the small intestine (SINENs) and of the appendix (ANENs) are presented herein. The small intestine, and especially the ileum, is one of the most common locations for these neoplasms. Most of them are well-differentiated and slow-growing tumours; uncommonly -neuroendocrine carcinomas. Their symptoms may be untypical, and their diagnosis may be delayed or accidental. Most often, the first manifestation of ANEN is their acute inflammation. Typical symptoms of carcinoid syndrome occur in approximately 20-30% of SINENs patients with distant metastases. In laboratory diagnostics, it is most useful to determine the concentration of chromogranin A (CgA) and assessment of urinary or plasma the 5-hydroxyindoleacetic acid concentration is helpful in the diagnosis of carcinoid syndrome. The most commonly used imaging methods are ultrasound (US) examination, computed tomography (CT), magnetic resonance imaging (MRI), colonoscopy, and somatostatin receptor imaging (SRI). Histopathological examination is crucial for the proper diagnosis and treatment of patients with SINENs and ANENs. The treatment of choice is a surgical procedure, either radical or palliative. Long-acting somatostatin analogues (SSAs) are essential in the medical treatment of functional and non-functional SINENs. In patients with SINENs, at the stage of dissemination with progression during SSAs treatment, with high expression of somatostatin receptors on functional imaging, radioligand therapy should be considered first followed by targeted therapies -everolimus. Recommendations for patient monitoring are also presented.

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“…Peptide-secreting functional NET could be detected by measuring serum levels of chromogranin, gastrin, vasoactive intestinal polypeptide (VIP), or calcitonin, as well as urine levels of 5-hydroxyindoleacetic acid. 2 …”

Section: Differential Diagnosismentioning

confidence: 99%