Endocrine Abstracts

JOINT1329

Neuroendocrine tumours are a rare, heterogeneous group of tumours arising from neuroendocrine cells, whose common feature is the production, accumulation and release of a biologically active hormone-like substance. They are dispersed in various tissues with the highest incidence in the gastrointestinal system. Most of the tumours grow slowly. They have a varied clinical symptomatology dependent on hormonal activity. Their occurrence is familial and sporadic. We present a case report of an 84-year-old biologically younger man with asymptomatic mild hypercalcaemia (3 mmol/l), which was a secondary finding on examination after a bicycle accident. CT scan of the abdomen revealed a bulky inhomogeneous lesion with a diameter of 8 cm with central disintegration in the right lobe of the liver, which was suspicious for metastasis. The patient’s current personal history includes chronic heart failure with preserved left ventricular ejection fraction in atrial fibrillation, moderate aortic stenosis, arterial hypertension, and multinodular goitre with laboratory signs of hyperthyroidism. Endoscopic sonography and FNAB confirmed a neuroendocrine tumour grade 1–2. The tumour cells were immunopositive for creatine kinase, chromogranin, synaptophysin and insulinoma-associated protein 1. In particular, the proliferative activity assessed by Ki67 in hot-spots was around 5%. As a part of staging, whole-body scintigraphy was added. SPECT/low dose CT scintigraphy with ^99mTc-Tektrotyd showed tumorous lesion with high somatostatin receptor expression in the caudate region of the pancreas and a disseminated lesion with marginally slightly increased somatostatin receptor expression in the right lobe of the liver. Paraneoplastic hypercalcemia (low PTH levels) was corrected with bisphosphonates. Considering the patient’s age, comorbidities and asymptomatic course of the disease, the multidisciplinary team indicated palliative hormone therapy with Somatuline.