PMID- 21948491
OWN - NLM
STAT- MEDLINE
DCOM- 20120210
LR  - 20181201
IS  - 1758-1001 (Electronic)
IS  - 0004-5632 (Linking)
VI  - 48
IP  - Pt 6
DP  - 2011 Nov
TI  - A patient with a metastatic gastroenteropancreatic endocrine carcinoma causing 
      hyperinsulinaemic hypoglycaemia and the carcinoid syndrome.
PG  - 579-83
LID - 10.1258/acb.2011.011068 [doi]
AB  - We present the case of a 57-year-old patient who initially presented with a 
      constellation of symptoms including intense pruritis, flushing and diarrhoea. 
      Following several months clinical deterioration, the patient was investigated 
      radiologically, where multiple hepatic tumours were identified. Liver biopsy 
      confirmed the presence of a well-differentiated metastatic gastroenteropancreatic 
      endocrine carcinoma with biochemical evidence of serotonin secretion. Over a 
      period of six months, the clinical course of the patient's disease progressed 
      whereby severe hypoglycaemia became the major manifestation. Subsequent 
      biochemical investigations confirmed the diagnosis of an insulinoma. Extensive 
      radiological investigation revealed a solitary primary pancreatic tumour, 
      indicating the presence of a metastatic pancreatic endocrine tumour (PET) 
      secreting both insulin and serotonin. The patient was treated with a chemotherapy 
      regimen consisting of 12 cycles of 5-fluorouracil/oxaliplatin, responding 
      clinically - improved World Health Organization performance score from 3 to 1, 
      biochemically - significantly reduced plasma chromogranin A and cancer antigen 
      19-9 concentrations and improved liver function tests, and radiologically - 
      reduced pancreatic and hepatic tumour size. This is the first report of a primary 
      PET secreting insulin and serotonin. Due to the association of 
      serotonin-secreting gastroenteropancreatic endocrine tumours (GEP-ETs) with 
      multiple endocrine neoplasia type-1 (MEN1) and biochemical evidence of an 
      insulinoma, MEN1 should also be considered in such cases. The case provides 
      further evidence for the biological heterogeneity of GEP-ETs and the myriad 
      secretory humoral products and resultant clinical syndromes arising from such 
      tumours.
FAU - Hinchliffe, E
AU  - Hinchliffe E
AD  - Department of Clinical Biochemistry, University Hospital of South Manchester, 
      Wythenshawe, Manchester M23 9LT, UK. ed_hinchliffe@hotmail.com
FAU - Allcock, R L
AU  - Allcock RL
FAU - Mansoor, W
AU  - Mansoor W
FAU - Myers, M A
AU  - Myers MA
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20110923
PL  - England
TA  - Ann Clin Biochem
JT  - Annals of clinical biochemistry
JID - 0324055
RN  - 0 (Antineoplastic Agents)
RN  - 0 (Organoplatinum Compounds)
RN  - 04ZR38536J (Oxaliplatin)
RN  - 12001-76-2 (Vitamin B Complex)
RN  - Q573I9DVLP (Leucovorin)
RN  - U3P01618RT (Fluorouracil)
SB  - IM
MH  - Antineoplastic Agents/administration & dosage
MH  - Antineoplastic Combined Chemotherapy Protocols/*therapeutic use
MH  - Bone Neoplasms/*secondary
MH  - Carcinoma/*secondary
MH  - Fluorouracil/administration & dosage
MH  - Humans
MH  - Hyperinsulinism/*diagnosis/etiology
MH  - Hypoglycemia/*diagnosis/etiology
MH  - Leucovorin/therapeutic use
MH  - Liver Neoplasms/*secondary
MH  - Malignant Carcinoid Syndrome/*diagnosis/etiology
MH  - Middle Aged
MH  - Organoplatinum Compounds/administration & dosage
MH  - Oxaliplatin
MH  - Pancreatic Neoplasms/complications/*diagnosis/drug therapy/pathology
MH  - Vitamin B Complex/therapeutic use
EDAT- 2011/09/29 06:00
MHDA- 2012/02/11 06:00
CRDT- 2011/09/28 06:00
PHST- 2011/09/28 06:00 [entrez]
PHST- 2011/09/29 06:00 [pubmed]
PHST- 2012/02/11 06:00 [medline]
AID - acb.2011.011068 [pii]
AID - 10.1258/acb.2011.011068 [doi]
PST - ppublish
SO  - Ann Clin Biochem. 2011 Nov;48(Pt 6):579-83. doi: 10.1258/acb.2011.011068. Epub 
      2011 Sep 23.