Background: Pancreatic Neuroendocrine Tumours (pNETs) can be associated with cancer susceptibility syndromes such as Multiple Endocrine Neoplasia type 1 (MEN1). MEN1 increases a persons chance of developing pNETs, which are the main cause of mortality in this cohort. A diagnosis of pNETs, therefore, provides the opportunity for detection of associated MEN1 and subsequent identification of asymptomatic relatives who would then undergo relevant clinical, biochemical and radiological surveillance.
Aims: The primary aim of this audit was to determine whether the local Wessex guidelines recommending biochemical screening for pNET patients were being followed. Screening for MEN1 consists of measuring serum calcium, parathyroid hormone (PTH), prolactin, IGF-1 (where there is clinical suspicion of acromegaly) as well as fasting gut peptide levels (10% of pNETs are estimated to be functional tumours).
Methods: A cohort of 64 patients [25 (39%) males and 39 (61%) females, average age of patients was 64.9±16.4 years] with a diagnosis of pNETs (ranging from grade 1 to grade 3) was retrospectively reviewed. In each patient, clinical & laboratory records were analysed in regards to whether they had been screened in accordance with our local guidelines.
Results: 100% of patients had calcium tested. 33% had PTH tested. 72% had results for a gut peptide assay. Prolactin was only tested in 25% of the cohort with 22% having a result for IGF-1. Within the cohort 6 patients were known to have MEN1.
Conclusion: The results of this audit indicated variability in the adherence to recommended screening. Whilst 100% of patients had calcium checked, investigations for PTH (especially in those with high calcium), prolactin and the gut peptides were not performed at the required level. These findings were shared with the multidisciplinary NET MDT professionals to emphasise the guidelines with the aim to repeat the audit after a period of implementation.