Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
Search for other papers by Le Tuan Linh in
Google Scholar
PubMed
Department of Radiology, Childrent’s Hospital 2, Ho Chi Minh city, Vietnam
Search for other papers by Nguyen Minh Duc in
Google Scholar
PubMed
Search for other papers by Hoang Tu Minh in
Google Scholar
PubMed
Search for other papers by Nguyen Ngoc Cuong in
Google Scholar
PubMed
Search for other papers by Vuong Thu Ha in
Google Scholar
PubMed
Search for other papers by Dao-Thi Luan in
Google Scholar
PubMed
Search for other papers by Thieu-Thi Tra My in
Google Scholar
PubMed
Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
Search for other papers by Bui Van Lenh in
Google Scholar
PubMed
Summary
Primary hepatic neuroendocrine tumor (PHNET) is a rare type of neuroendocrine tumor (NET) that is also a primary hepatic tumor. Patients are present with almost no specific clinical symptoms and typically present with negative test results and atypical imaging characteristics; therefore, the differentiation of PHNET from other types of primary hepatic masses can be very difficult. In this article, we describe a case of PHNET that mimicked a liver helminth infection in a 57-year-old man. The diagnosis of PHNET in this patient was challenging, and the final diagnosis was based on imaging, histopathology features, and long-term follow-up.
Learning points
-
An uncommon type of neuroendocrine tumor (NET) is a primary hepatic neuroendocrine tumor (PHNET).
-
Primary hepatic neuroendocrine tumors are rare NET lesions found in the liver, characterized by non-specific clinical and imaging results, which can be easily confused with other liver lesions, including HCC and parasitic lesions.
-
To have a conclusive diagnosis and classification, a mixture of many medical assessment techniques, such as imaging, gastrointestinal endoscopy, nuclear medicine, anatomy, including histopathology, and immunohistochemistry, is essential.
Department of Endocrinology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
Search for other papers by Nam Quang Tran in
Google Scholar
PubMed
Search for other papers by Chien Cong Phan in
Google Scholar
PubMed
Search for other papers by Thao Thi Phuong Doan in
Google Scholar
PubMed
Department of Endocrinology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
Search for other papers by Thang Viet Tran in
Google Scholar
PubMed
-adrenal tuberculosis. Case presentation A previously healthy, nonsmoker, 39-year-old Vietnamese male presented to the gastroenterology outpatient clinic with a 3-day history of worsening recurrent nausea, vomiting, diarrhoea, and stomach upset. He reported
Search for other papers by Sarah Ying Tse Tan in
Google Scholar
PubMed
Search for other papers by Swee Ping Teh in
Google Scholar
PubMed
Search for other papers by Manish Kaushik in
Google Scholar
PubMed
Search for other papers by Tze Tein Yong in
Google Scholar
PubMed
Search for other papers by Shivani Durai in
Google Scholar
PubMed
Search for other papers by Claudia Jong-Chie Tien in
Google Scholar
PubMed
Search for other papers by Daphne Su-Lyn Gardner in
Google Scholar
PubMed
Summary
Gestational hypertriglyceridemia-induced pancreatitis is associated with significant maternal and fetal morbidity and mortality. We report a case of gestational hypertriglyceridemia-induced pancreatitis in a primigravida at 31-weeks gestation, complicated by impending preterm labor and metabolic acidosis requiring hemodialysis. This was successfully managed with therapeutic plasma exchange (TPE), followed by i.v. insulin, low-fat diet, and omega-3. Triglyceride levels stabilized after TPE and the patient underwent an uncomplicated term delivery. In pregnancy, elevated estrogen and insulin resistance exacerbate hypertriglyceridemia. Management is challenging as risks and benefits of treatment options need to be weighed against fetal wellbeing. We discuss management options including a review of previous case reports detailing TPE use, dietary optimization, and delivery timing. This case emphasizes the importance of multidisciplinary care to optimize maternal and fetal outcomes.
Learning points
-
Gestational hypertriglyceridemia-induced pancreatitis has high morbidity.
-
A multidisciplinary team approach is a key as maternal and fetal needs must be addressed.
-
Rapid lowering of triglycerides is crucial and can be achieved successfully and safely with plasma exchange.
-
A low-fat diet while ensuring adequate nutrition in pregnancy is important.
-
Timing of delivery requires consideration of fetal maturity and risk of recurrent pancreatitis.
Search for other papers by Sally K Abell in
Google Scholar
PubMed
Search for other papers by Jessie Teng in
Google Scholar
PubMed
Search for other papers by Anthony Dowling in
Google Scholar
PubMed
Molecular Imaging, Centre for Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Melbourne, Victoria, Australia
Search for other papers by Michael S Hofman in
Google Scholar
PubMed
Department of Medicine, University of Melbourne, Parkville, Melbourne, Victoria, Australia
Search for other papers by Richard J MacIsaac in
Google Scholar
PubMed
Search for other papers by Nirupa Sachithanandan in
Google Scholar
PubMed
Summary
This paper details the case of a 77-year-old male with refractory hypoglycaemia due to inoperable metastatic pancreatic neuroendocrine tumour (pNET) co-secreting insulin and gastrin. Multiple medical therapies were trialled with limited success, and we describe the complications experienced by our patient. Somatostatin analogues can ameliorate hypoglycaemia and may have tumour-stabilising effects; however, in our case resulted in paradoxical worsening of hypoglycaemia. This rendered our patient hospital dependent for glycaemic support including continuous dextrose infusion. Although this is a reported adverse effect with initiation of therapy, we describe successful initiation of short-acting octreotide as an inpatient followed by commencement of long-acting octreotide. Hypoglycaemic collapse occurred only after dose titration of long-acting octreotide. We outline the pitfalls of somatostatin analogue therapy and the mechanisms that may contribute to worsening hypoglycaemia. This rare side effect cannot be reliably predicted, necessitating close supervision and glucose monitoring during therapy. Our patient achieved disease stabilisation and gradual resolution of hypoglycaemia with peptide receptor radionuclide therapy (PRRT), an emerging therapeutic option for metastatic neuroendocrine tumours with high efficacy and low toxicity. We present a brief but comprehensive discussion of currently available and novel therapies for insulin secreting pNETs.
Learning points
-
Hypoglycaemia due to malignant insulin secreting pNET is frequently severe and may be life-threatening despite supportive therapies.
-
Octreotide can ameliorate hypoglycaemia, and may have anti-proliferative and tumour-stabilising effects in malignant pNETs that are surgically unresectable.
-
Paradoxical worsening of hypoglycaemia may occur with octreotide initiation and dose titration, necessitating close supervision and glucose monitoring.
-
PRRT is emerging as a therapeutic option with high efficacy and low toxicity.
Search for other papers by Clare E Bonnar in
Google Scholar
PubMed
Search for other papers by John F Brazil in
Google Scholar
PubMed
Search for other papers by Julie O Okiro in
Google Scholar
PubMed
Search for other papers by Louise Giblin in
Google Scholar
PubMed
Search for other papers by Yvonne Smyth in
Google Scholar
PubMed
Search for other papers by Paula M O’Shea in
Google Scholar
PubMed
Search for other papers by Francis M Finucane in
Google Scholar
PubMed
over 15 years, all were men, one was of Black African ethnicity and the rest were of Asian (Korean, Filipino, Hispanic and Vietnamese) ethnicity ( 4 ). Hypokalaemia and paralysis are thought to arise from over-stimulation of Na-K-ATPase, with potassium
