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Symptoms |
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Gastro-entero-pancreatic neuroendocrine (GEP NE) tumours are divided into 2 subgroups:
- Functional tumours-tumours with a clinical syndrome
- Nonfunctional tumours-tumours without a clinical syndrome
Often, in the early stages of GEP NE disease, no signs or symptoms are present. When symptoms occur, they may be related to the excessive release of hormones (such as peptides) and other substances (such as biogenic amines) produced by the tumour. This may occur because the tumour is unable to:
- Store newly synthesized hormone or biogenic amines within the cell
- Respond to a physiological feedback mechanism that regulates release of the hormone
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Symptoms
of GEP NE tumours
The most common symptoms of GEP NE tumours
are diarrhoea and flushing. Flushing is red or purple colouring
that appears suddenly on the face or neck and may be accompanied
by a feeling of warmth or a rapid heartbeat. Additional symptoms
may include abdominal pain and heart disease.
- Flushing
- Diarrhoea
- Heart valvular lesions
- Cramping
- Bloating
- Sweating
- Telanglectasia
- Wheezing
- Peripheral oedema
- Palpitations
- Cyanosis
- Pellagra
- Arthritis
Generally, the symptoms of GEP NE tumours vary depending on the
tumour. Each type of tumour secretes different hormones that cause
different symptoms. Following are the types of GEP NE tumours
and their associated symptoms:
- Carcinoid tumours: Symptoms include diarrhoea,
flushing, cramp-like pain in the abdomen, swelling of the skin
or the face and neck, wheezing, and symptoms of heart failure,
including shortness of breath
- Insulinomas (hypoglycaemic syndrome): Symptoms
are related to neuroglucopenia and catecholamine release and
include blurred vision, diplopia, weakness, palpitations, and
confusion or bizarre behaviour. Hypoglycaemia tends to occur
5 hours or more after a meal, and the associated symptoms may
be affected by diet, ingestion of ethanol and exercise.
- Gastrinomas: Symptoms include diarrhoea,
gastritis and recurrent gastric ulcers. Of these tumours, 20%
to 25% are related to multiple endocrine neoplasia type I and
50% to 70% are malignant (lymph node metastases)
- Vasoactive intestinal peptide (VIP) tumours (VIPomas;
Verner-Morrison syndrome): Symptoms include watery
diarrhoea (3 to 20 litres a day), hypokalaemia due to the loss
of potassium and bicarbonate in the stool, hypomagnesaemia,
hypercalcaemia, acidosis, flushing, flaccid distended bladder,
and ileus/subileus. Diabetes or glucose intolerance also is
common
- Glucagonomas: Affects hepatic glucose production
and causes symptoms such as necrolytic erythematous rash (often
on the face, extremities, and intertriginous areas, affecting
more than 80% of patients), anaemia, weight loss, impaired glucose
tolerance, thrombosis, and diarrhoea
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