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Pancreatic Neuroendocrine Tumor Producing Insulin and Vasopressin
- Source :
- Endocrine pathology. 29(1)
- Publication Year :
- 2017
-
Abstract
- The objective of the study is to report a rare case of pancreatic neuroendocrine tumor (pNET) producing insulin and vasopressin. We describe the clinical presentation and management of a metastatic pNET with refractory hypoglycemia and progressive severe hyponatremia. A 52-year-old patient had abdominal pain leading to the diagnosis of a tumor that was initially presumed to be splenic in origin. Investigations ultimately identified a pancreatic mass that on biopsy proved to be a pNET. Eventually, he developed extensive liver metastases, and with tumor progression, he manifested hypoglycemia and severe hyponatremia. He was managed with multiple therapies including somatostatin analogue, peptide-receptor-radionuclide-therapy (PRRT), diazoxide, and everolimus; none of these therapeutic modalities was successful in controlling functional and structural progression of the tumor. Ultimately, the pNET proved fatal and autopsy confirmed widely metastatic disease that stained strongly and diffusely for vasopressin, a feature not seen in the previous liver biopsy. This case illustrates the challenges of diagnosis and management of aggressive insulin-producing pNETs and highlights the potential concomitant ectopic production of vasopressin leading to refractory hyponatremia.
- Subjects :
- Male
Vasopressin
Pathology
medicine.medical_specialty
Vasopressins
Endocrinology, Diabetes and Metabolism
030209 endocrinology & metabolism
Neuroendocrine tumors
Hypoglycemia
Pathology and Forensic Medicine
Inappropriate ADH Syndrome
03 medical and health sciences
0302 clinical medicine
Endocrinology
Biopsy
medicine
Pancreatic mass
Humans
Insulin
Protein Precursors
Neurophysins
medicine.diagnostic_test
business.industry
General Medicine
Middle Aged
medicine.disease
Pancreatic Neoplasms
Neuroendocrine Tumors
Tumor progression
030220 oncology & carcinogenesis
Liver biopsy
business
Hyponatremia
Subjects
Details
- ISSN :
- 15590097
- Volume :
- 29
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Endocrine pathology
- Accession number :
- edsair.doi.dedup.....5c9f052b6c298e692d0df40f6f30ee16