Endocrine Abstracts

Neuroendocrine neoplasia (NENs) are rare tumours that show features of neuroendocrine differentiation. Generally, NENs can be subdivides into high-grade neuroendocrine carcinomas (NECs) and low-to-intermediate grade neuroendocrine tumours (NETs). The most common Endodermal NETs’ localisations are the lungs, ileum, appendix, and rectum. Neuroectodermal NETs include medullary thyroid cancer (MTC), pheochromocytoma (PHEO), and paraganglioma (PGL). Nets are estimated to occur with an incidence rate of 1 –- 3.5 per 100.000 in the general population. We report two cases of NET that were incidentally identified in the absence of any symptoms in obese women programmed to undergo bariatric surgery. Case 1: A 45-year-old white female with liver steatosis was scheduled to undergo bariatric surgery. An endoscopic investigation showed a sessile duodenal lesion with 1 cm of height. The patient denied any symptoms of carcinoid syndrome. Magnetic resonance revealed a tumour in the left adrenal gland of two cm. PET scan detected lesion in pancreas with somatostatin receptors. The patient underwent surgical removal of pancreas head and body and tumoral resection in duodenum. Pathology studies identified neuroendocrine tumour with immunohistochemistry positive for AEI, chromogranin A, synaptophysin and K1-67. Patient is now three months postoperative with BMI of 38 kg/m². Resting metabolic rate 2187 kcal/day with Harris Benedict resulted 126%. Case 2: A 39-year-old Hispanic asymptomatic female was programmed to bariatric surgery. A preoperative USG and MRI showed a wide expanding lesion in the right kidney measuring 17×16×14 cm, with moderate hydronephrosis. A nephrectomy was performed with pathology studies identifying a well-differentiated neuroendocrine tumour presenting immunohistochemistry positive to AEI, chromogranin A, synaptophysin and K1-67. Six months after surgery her BMI is 36.3 kg/m². Resting metabolic rate 2430 kcal/day and Harris Benedict resulted 140%. Although NETs are considered rare, their incidence is higher in the obese population compared to general populations. As they are asymptomatic, their finding can occur during preoperative examinations. Indirect calorimetry showed normal basal energy expenditure in both patients. Obesity may play a role in the pathogenesis of these tumours. In the light of this association, this present case report denotes the need for meticulous preoperative evaluation in this population.