Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2018) 59 CMW3.1 | DOI: 10.1530/endoabs.59.CMW3.1

SFEBES2018 Clinical Management Workshops Workshop 3: How do I. . . (1) (6 abstracts)

How Do I\.\.Manage Diarrhoea in Patients with NETs

Mark Strachan


Edinburgh Centre for Endocrinology and Diabetes, Edinburgh, UK.


Diarrhoea is a common symptom in patients with neuroendocrine tumours (NETs), especially metastatic small bowel NETs. Diarrhoea substantially impairs quality of life, as increased frequency of bowel moments with associated urgency, cause social embarrassment and constrain diet and the ability to leave the house. Diarrhoea, with associated electrolyte disturbance, was a major cause of premature death in patients with NETs prior to the advent of medical therapies. It is important to remember that diarrhoea in patients with NETs is not necessarily hormonally-mediated. Other causes include short-bowel syndrome (due to surgical resection of bowel), exocrine pancreatic insufficiency (following pancreatic resection and as a side effect of somatostatin analogue (SSA) therapy), small bowel bacterial overgrowth (due to ‘blind loops’ following certain surgical procedures) and bile acid malabsorption (due to terminal ileal disease). Anti-motility agents (e.g. loperamide and codeine) are the mainstay of management of short-bowel syndrome and can be effective in other forms of diarrhoea too. Exocrine pancreatic enzyme supplements, cyclical courses of antibiotics and bile acid sequestrants (e.g. colestyramine) should be considered in relevant situations. Hormonal causes of diarrhoea in NETs include serotonin (small bowel carcinoids), vasoactive intestinal peptide (rare pancreatic NETs) and calcitonin (medullary thyroid cancer). SSAs are the key treatment in the management of hormonally-mediated diarrhoea in patients with NETs. SSAs can transform quality of life and also have anti-tumour properties. Intractable diarrhoea, despite optimum SSA therapy, should prompt evaluation for non-hormonal causes as above, but if symptoms persist then additional anti-cancer treatments may improve diarrhoea by reducing hormone section. Options include peptide receptor radionuclide therapy, multi-kinase inhibitor therapies and local cyto-reduction techniques. Telotristat is an inhibitor of tryptophan hydroxylase, one of the key enzymes in the serotonin synthesis pathway. Trials have shown that it can reduce the frequency of diarrhoea in patients with diarrhoea due to serotonin excess.

Volume 59

Society for Endocrinology BES 2018

Glasgow, UK
19 Nov 2018 - 21 Nov 2018

Society for Endocrinology 

Browse other volumes

Article tools

My recent searches

No recent searches.

My recently viewed abstracts