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Neuroendocrine Tumours

Maladywise

Neuroendocrine Neoplasms = (NENs)

Types

  • Well-differentiated neuroendocrine tumours (NETs)

    • Traditionally called carciinoid tumours

    • 5 year survival 67%

  • Poorly differentiated neuroendocrine carcinomas (NECs)

    • Resembled small or large cell carcinomas

    • Poor outcome

Pancreas

  • Insulinoma = episodic hypocglycaemia, confusion, visual change, unusual behaviour, dipahoresis, tremor, amnesia.

  • Gastrinomas = Peptic ulcer disease, diarrhoea

  • Glucagonoma = necrolytic migrating erythema, diabetes, anaemia, weight loss, diarrhoea, neuropsychiatric symptoms

  • VIPoma = watery diarrhoea, hypokalemia, hypochloria.

Carcinoid

  • 40 secretory products in carcinoid syndrome

  • Tryptophan

    • 1% of tryptophan converted to serotonin normally

    • In carcinoid this is up to 70%

  • Histamine

    • Some convert to histamine instead

    • Flushing, pruritus

  • Kallikrein

    • Leads to Bradykinin

    • Flushing, increased intestinal motility

  • Prostaglandins

    • Stimulate intestinal motility

  • Tachykinin

    • SubstanceP + A + Neuropeptide K

    • Flushing and diarrhoea

Carcinoid Signs

  • Venous telangectasia

  • Diarrhoea

  • Bronchospasm

  • Cardiac valvular lesions

  • Flushing

Lung NECs

  • Non hormonal symptoms

    • Obstruction

    • Haemoptysis

    • Cough, wheeze

    • Chest pain

    • Recurrent pneumonia

  • Carcinoid

    • As above

  • Cushing’s

    • ACTH secreting

  • Acromegaly

    • GHRH secreting

  • DIPNECH

    • Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia

    • Respiratory symptoms

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