Endocrine Abstracts

High grade pancreatic NETs are usually non-functional. Here, we report a case of a patient with a high grade pancreatic NET, which was initially non-functional but became functional after chemotherapy. He was initiated on a flash glucose monitoring device (FreeStyle Libre®) avoiding the need for frequent capillary blood glucose monitoring. Using this novel approach, we demonstrated an improvement in his disabling hypoglycaemia with medical treatment. A 45-year-old profess...

Neuroendocrine tumours (NETs) are rare cancers originating from neuroendocrine cells. The estimated prevalence is 35 per 100,000 people per year. A comparative review was conducted at the University Hospitals of Leicester (UHL) to determine the outcomes of treated neuroendocrine patients.Methods: Patients were identified via pharmacy records of Lanreotide, from April 2009 – March 2018. Clinical data was obtained from hospital notes and histopatholog...

Background: Neuroendocrine tumours (NETs) are often associated with SPMs. This study aimed to identify SPMs in patients with non-pulmonary wdNETs.Methods: Patients seen at The Christie with non-pulmonary wdNETs from 2003–2017 were included. After exclusion of patients with hereditary predispositions, notes were retrospectively reviewed for location, functionality, treatment and temporal relation to diagnosis.Results: Of 854 pa...

Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia (DIPNECH), which was formally recognised in 1992, has been described as an idiopathic pre-invasive condition that may co-exist with carcinoid tumours. Classically it has been described in women with predominantly obstructive lung function and not in association with smoking. Although many have stable disease, in some documented cases there has been progressive lung disease leading to the need for lung transplant. The...

We present the case of a 26 year old female who presented unusually at the age of 19 with left basal pneumonia. This was deemed to resolve on follow up chest X-ray, however she was given a diagnosis of asthma and used a salbutamol inhaler for wheeze. She re-presented with a left lower lobe pneumonia in 2018, which did not resolve with antibiotics. She was re-admitted a month later and noted to have a left lower lobe collapse. She underwent a bronchoscopy which showed a proxima...

Background: Merkel cell carcinoma (MCC) is a neuroendocrine tumour of the skin. It is a rare, highly aggressive cancer with a high propensity for recurrence and an increasing incidence rate. Feedback from patients and clinicians suggests there is very little accessible MCC specific patient information and support available. To improve patient access to accurate and reliable information and support, the NET Patient Foundation are developing existing services to provide MCC spec...

Background: Bone metastases (BMs) are rare in neuroendocrine neoplasms (NENs). There is no global consensus on the optimal management, and treatment is often extrapolated from experience in other tumour groups. The aim of this study was to review the current management and outcomes of patients with BMs in NENs.Method: A retrospective study was performed of all patients with NENs, except G3 lung NENs, treated at a tertiary centre from April 2002–Marc...

Background: People who have autoimmune atrophic gastritis commonly develop type 1 gNETs, but are also at increased risk of developing gastric adenocarcinoma. Type I gNET patients usually have multiple gastric polyps and have an excellent prognosis when the polyps measure.Method: Retrospective audit of type I gNET patients managed within Liverpool ENETS Centre of Excellence 2004–2018.Results: 86 patients (median age 67 years, 5...

Background: Very little is written regarding injection site reactions to somatostatin analogues and although very rare we are unprepared in dealing with these reactions. Patients are then met with an uncertain clinical team leading to significant delay in treatment. This poster aims to highlight the potential risks of injection site reactions by sharing an extreme case study. It will also share our attempt to deal with injection site reactions, lesson learnt and recommendation...

Noninfectious pneumonitis is a recognised toxicity associated with mTOR inhibitors, such as everolimus. We report a 75 year old female with histologically confirmed on colonoscopy, non-functioning Grade 2 (Ki 9%) in situ terminal ileal NET with ileocolic lymphadenopathy and multiple liver metastases, who was commencedon somatostatin analogue therapy at presentation in May 2017, but developed progressive disease on CT by February 2018. Based on RADIANT – 4 which s...

Background: Sarcopenia is characterised by a loss of muscle mass and function and is negatively correlated with quality of life and clinical outcomes. It may be present despite a healthy or even high body mass index (BMI). Up to a quarter of NET patients are at risk of malnutrition, which may impact treatment outcomes and length of hospital stay. Research has shown that patients with pancreatic and intestinal NETs are at higher risk of weight loss than bronchial NETs. With an ...

Introduction: Accurate survival data for patients with neuroendocrine tumours (NETs) across the UK has been difficult to capture. Individual centres often report good survival rates, however, national data has not previously been available. Pulmonary neuroendocrine tumours (NETs) cover a spectrum of histological disease, including typical carcinoid, atypical carcinoid and large cell neuroendocrine carcinoma. Surgical resection with curative intent is advocated in the majority ...

Background: The diagnosis of neuroendocrine tumor disease has been tardy due to a lack of sensitive, noninvasive technology to facilitate identification. In the 1960’s, diagnosis required tumor tissue attained by surgery or biopsy. Identification was by histopathology and immunohistochemistry (1975). Acquisition of information was limited by the morbidity of invasive strategies, inability to reassess and interpretation was user-dependent with low kappa values. The introdu...

Background: Predicting and monitoring PRRT is based upon NET overexpression of somatostatin receptor (SSR) to deliver targeted isotope therapy. Imaging SSR expression is ~60% accurate as a predictor of efficacy. However, it and other imaging modalities e.g., CT/MRI, have utility for monitoring response. Specific blood NET gene expression (Positive Predictor Quotient- [PPQ]) is accurate in predicting PRRT response (93–97%, Bodei et al. EJNMMI 2018). The utility of NET tran...

Background: There are no effective blood biomarkers for bronchopulmonary carcinoids (BPC). We examined the utility of a neuroendocrine multigene transcript ‘liquid biopsy’ (NETest) in bronchopulmonary carcinoids (BPC) for diagnosis and monitoring of disease status.Aim: To independently validate the utility of the NETest in diagnosis and management of BPC in a prospective multicenter, multinational blinded study.Material a...

Background: The NETest, a neuroendocrine multigene transcript ‘liquid biopsy’, is a novel biomarker for GEP-NETs. Current biomarkers are monoanalyte amines or peptides whereas the NETest is a multianalyte signature providing molecular biological information pertinent to clinical disease.Aim: Independently validate the utility of the NETest for the diagnosis of GEP-NETs and identification of disease progression.Material an...

Introduction: Choline PET-CT is a recognised modality for imaging prostate cancer; both for initial staging and restaging. It is, however, a non specific tracer and is also positive in numerous other conditions such as inflammatory processes and other malignancies.Method: We present a case of a 60 year old patient with a PSA of 9 ng/ml and a firm abnormal right prostate lobe. Prostate MRI demonstrated a lesion in the apex of the prostate but no associate...

Background: Pancreatic neuroendocrine tumours (panNETs) are rare tumours (prevalence 4/100,000). Diagnosis and staging of panNETs requires biochemical screening, cross-sectional imaging (with CT/MRI), endoscopic ultrasound (EUS) and where available, functional imaging using 68Ga-labelled synthetic octreotide analogues using PET-CT due to its reported higher sensitivity and specificity.Methods: A retrospective, electronic case note study was ca...

Imaging in paragangliomas can be challenging as they arise from a number of locations including the adrenals, abdomen, pelvic and thoracic sites of chromaffin sympathetic tissue. They can also arise in the head and neck at sites of parasympathetic tissue. They are considered within the group of heterogenous neuroendocrine tumours. In addition to manifesting at multiple sites, they can metastasise, have variable expression of catecholamines and can be a manifestation of heredit...

Introduction: Liver is the most common site in patients with advanced small bowel neuroendocrine neoplasms (SBNEN) and distant metastases. On the contrary, lung metastases are relatively uncommon, occurring in 5–13.6% of patients. Although hepatic metastases often progress and have implications to the disease outcome, not enough data are available for lung metastases.Aim: Our aim was to assess the incidence of chest (including lung, mediastina/hilar...

We present the case of a 51-year-old woman who attends the NET service at the Oxford University Hospitals Trust with multiple known secretory paragangliomas (predominantly 3-methoxythyramine), including a carotid body tumour and, most recently, an intrapericardial paraganglioma. She is SDHC mutation positive. Multiple surgical resections of paragangliomas, at sites other than the cardiac lesion, had previously been undertaken. Due to disease progression and symptomati...

Insulinoma is a rare pancreatic neuro endocrine tumour. It is the commonest cause for endogenous hyperinsulinaemic hypoglycemia in a seemingly well individual. Insulinomas are small tumors which may not be detected on conventional imaging modalities. Image negative endogenous hyperinsulinemia poses a diagnostic challenge to the clinicians. Interventional radiological techniques with higher sensitivity can be used in such situations for correct localization of the small s for b...

Introduction: NETs are a diverse group of neoplasms that originate from cells of the diffuse endocrine system. Often somatostatin analogues (SSA) are used as a first line treatment. Loose stools and steatorrhea are common adverse effects of SSA. This can affect the absorption of fat soluble vitamins and trace elements (TE). In this study we assess the prevalence of these deficiencies.Methods: A prospective study of 66 patients on SSA. Vitamins A,D,E,K an...

Background: TGR represents the percentage change in tumour volume per month (%/m). Previous results from the GREPONET study (A. Lamarca et al, ENETS 2018) showed that TGR measured after 3 months (TGR3m) of starting systemic treatment (ST) or watch and wait (WW) was an early biomarker predicting progression-free survival (PFS) in NETs.Methods: Pts from 7 centres with advanced grade (G) 1/2 NETs from the pancreas (P)/small bowel (SB) initiating ST...

Pulmonary neuroendocrine tumors (NET) are well recognized, but quite an uncommon group of disorders to cause ectopic Cushing’s syndrome. Pulmonary NETs have also undergone a change in treatment paradigms. We present a 62 year old female with incidentally detected left lower lobe lung nodule with biopsy proven well differentiated NET with ki67 index of 5–10% in 2011. She had a metachronous slow growing left sided renal tumor (hypernephroma), long standing type 2 diabe...

The prevalence of bronchial carcinoid, both typical (TC) and atypical (AC), has increased significantly over the past 30 years, most likely as a consequence of better awareness and diagnostic tools e.g. carcinoid specific immunohistochemistry stains. The peak incidence of TC and AC are in the fourth and fifth decades of life respectively. Diagnosis at younger ages is much rarer although carcinoid represents one of the commonest pulmonary tumours in children, teenagers and youn...

The imaging of neuroendocrine tumours (NET) is multimodal and is often initiated by cross sectional imaging, usually CT. Imaging with CT demonstrates metastatic disease more frequently than locating the primary lesion. Subsequent imaging relies on somatostatin receptor (SSR) scintigraphy, usually with the use of indium octreotide. SSR scintigraphy is commonly supplemented with SPECT CT to help localise the sites of metastatic deposits more accurately by delineating the associa...

Background: Pancreatic neuroendocrine tumours (panNETs) may arise as part of an underlying genetic condition such as multiple endocrine neoplasia type 1 (MEN type 1). The value of functional imaging using 68Ga-labelled synthetic octreotide analogues using PET-CT has not been extensively evaluated in patients with MEN1 to determine its value.Methods: We investigated the effect of 68Ga-based PET-CT imaging on patient management in pat...