The Diagnosis of Neuroendocrine Tumours: An Endocrine Perspective

Çakır, Mehtap; Grossman, Ashley

doi:10.25179/tjem.2018-59949

Cited by 2 publications

(3 citation statements)

References 78 publications

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“…The SLR identified qualitative data reporting several other differential causes of diarrhoea, including laxative abuse[ 42 , 43 ], dumping syndrome[ 44 ], lymphangiectasia[ 45 ] and pneumatosis cystoides intestinalis (PCI) induced by sunitinib treatment[ 46 ]. Diarrhoea that can develop due to exacerbation or progression of CS was also reported, such as niacin deficiency/pellagra[ 24 , 45 , 47 , 48 ], and adverse events of serotonergic medication[ 49 ]. Of five case reports, two reported on infectious diarrhoea[ 50 , 51 ], two on bowel obstruction[ 52 , 53 ] and one on sunitinib-induced PCI[ 46 ].…”

Section: Resultsmentioning

confidence: 99%

“…Approaches for inferring the cause of diarrhoea: Characteristics of diarrhoea associated with specific causes were described by 14 articles[ 24 , 31 , 38 , 39 , 42 - 45 , 47 , 48 , 50 , 58 - 60 ], and five articles described concomitant symptoms that may be present and may assist in a differential diagnosis ( )[ 6 , 44 , 50 , 60 , 61 ]. Characteristics and symptoms described in the literature were as follows: Diarrhoea due to PEI was described as greasy, foul-smelling, floating stools[ 24 , 42 - 45 , 47 , 59 ], known clinically as steatorrhoea; patients with PEI may also have bloating, weight loss and signs of malabsorption[ 6 , 44 , 60 ]; BAM diarrhoea may be choleretic[ 61 ]; patients with SIBO may experience a change from initially intermittent diarrhoea (caused by CS) to continuous diarrhoea, with associated flatulence, bloating and borborygmic sounds[ 61 ]; characteristics of SBS diarrhoea were not reported, but other symptoms may include significant weight loss, electrolyte disturbance and hydration issues[ 61 ].…”

Section: Resultsmentioning

confidence: 99%

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Differential diagnosis of diarrhoea in patients with neuroendocrine tumours: A systematic review

Khan

Walter

Buchanan-Hughes

et al. 2020

WJG

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BACKGROUND Approximately 20% of patients with neuroendocrine tumours (NETs) develop carcinoid syndrome (CS), characterised by flushing and diarrhoea. Somatostatin analogues or telotristat can be used to control symptoms of CS through inhibition of serotonin secretion. Although CS is often the cause of diarrhoea among patients with gastroenteropancreatic NETs (GEP-NETs), other causes to consider include pancreatic enzyme insufficiency (PEI), bile acid malabsorption and small intestinal bacterial overgrowth. If other causes of diarrhoea unrelated to serotonin secretion are mistaken for CS diarrhoea, these treatments may be ineffective against the diarrhoea, risking detrimental effects to patient quality of life. AIM To identify and synthesise qualitative and quantitative evidence relating to the differential diagnosis of diarrhoea in patients with GEP-NETs. METHODS Electronic databases (MEDLINE, Embase and the Cochrane Library) were searched from inception to September 12, 2018 using terms for NETs and diarrhoea. Congresses, systematic literature review bibliographies and included articles were also hand-searched. Any study designs and publication types were eligible for inclusion if relevant data on a cause(s) of diarrhoea in patients with GEP-NETs were reported. Studies were screened by two independent reviewers at abstract and full-text stages. Framework synthesis was adapted to synthesise quantitative and qualitative data. The definition of qualitative data was expanded to include all textual data in any section of relevant publications. RESULTS Forty-seven publications (44 studies) were included, comprising a variety of publication types, including observational studies, reviews, guidelines, case reports, interventional studies, and opinion pieces. Most reported on PEI on/after treatment with somatostatin analogs; 9.5%-84% of patients with GEP-NETs had experienced steatorrhoea or confirmed PEI. Where reported, 14.3%–50.7% of patients received pancreatic enzyme replacement therapy. Other causes of diarrhoea reported in patients with GEP-NETs included bile acid malabsorption (80%), small intestinal bacterial overgrowth (23.6%-62%), colitis (20%) and infection (7.1%). Diagnostic approaches included faecal elastase, breath tests, tauroselcholic (selenium-75) acid (SeHCAT) scan and stool culture, although evidence on the effectiveness or diagnostic accuracy of these approaches was limited. Assessment of patient history or diarrhoea characteristics was also reported as initial approaches for investigation. From the identified evidence, if diarrhoea is assumed to be CS diarrhoea, consequences include uncontrolled diarrhoea, malnutrition, and perceived ineffectiveness of CS treatment. Approaches for facilitating differential diagnosis of diarrhoea include improving patient and clinician awareness of non-CS causes and involvement of a multidisciplinary clinical team, including gastroenterologists. CON...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Differential diagnosis of diarrhoea in patients with neuroendocrine tumours: A systematic review

Khan

Walter

Buchanan-Hughes

et al. 2020

WJG

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show abstract

“…The presentation can be divided into two broad subcategories: where we seek the NENs (based on hormone-related symptoms, physician orders test to find out NENs) or NEN seeks us (incidentally discovered when a radio-imaging or endoscopy is done for some other indication, where NEN was not the primary suspect). [ 9 ] The latter situation is far more common as most GEP-NENs are indolent and nonfunctional. However, few of them can present with local mass effect-related features like gut obstruction or bleeding.…”

mentioning

confidence: 99%

Neuroendocrine neoplasm: Current understanding

Lila¹,

Memon²

2023

Journal of Postgraduate Medicine

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The Diagnosis of Neuroendocrine Tumours: An Endocrine Perspective

Cited by 2 publications

References 78 publications

Differential diagnosis of diarrhoea in patients with neuroendocrine tumours: A systematic review

Differential diagnosis of diarrhoea in patients with neuroendocrine tumours: A systematic review

Neuroendocrine neoplasm: Current understanding

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