What is peptide receptor radioligand therapy? Peptide receptor radioligand therapy takes advantage of the presence of somatostatin receptors on NETs to deliver radiopharmaceuticals directly to these tumors. NETs that show significant tracer uptake on somatostatin receptor–based functional imaging (68-Ga DOTATATE or In-111 pentetreotide) can subsequently be treated with one of several labeled analogues, such as …
Are chemotherapy regimens effective in the treatment of carcinoid tumors? Cytotoxic chemotherapy has yielded disappointing results in patients with carcinoid syndrome. Etoposide–cisplatin combination therapy is the most commonly used regimen for poorly differentiated carcinoid tumors. Everolimus, an antagonist of mammalian target of rapamycin (mTOR), and vascular endothelial growth factor receptor (VEGF-R) antagonists, such as vatalanib, …
What medications may be effective when somatostatin analogues do not adequately control carcinoid symptoms? Telotristat is an orally administered inhibitor of tryptophan hydroxylase, the rate-limiting step in serotonin synthesis. Telotristat used in combination with somatostatin analogues has been shown to significantly reduce both 5-HIAA excretion and diarrhea. This agent may also be effective in preventing …
Medications for Relief of Symptoms of Carcinoid Syndrome Read More »
How are carcinoid syndrome symptoms controlled? The most troublesome symptoms patients with carcinoid syndrome experience are intense flushing and secretory diarrhea. Long-acting somatostatin analogues (octreotide, lanreotide) are the most effective available medications for controlling these carcinoid symptoms because approximately 80% of NETs express somatostatin receptors. Recommended starting doses are intramuscular octreotide LAR 20 to 30 …
Biochemical mediators of carcinoid syndrome Carcinoid syndrome results from humoral mediators secreted by NETs that reach the systemic circulation. Carcinoid syndrome does not usually occur with midgut NETs unless there are extensive liver metastases that impair mediator metabolism in the liver or that secrete mediators directly into the circulation via the hepatic vein. Extraintestinal carcinoids …
Hormones and Aging • Most hormonal axes are associated with a gradual age related changes over time, beginning at about age 30 years, with the exception of a relatively rapid decline in estradiol during the menopause transition in women. • Serum total testosterone concentrations decrease gradually with age in men, but numerous other factors could be contributing …
What medications should be considered for the treatment of type 2 diabetes in older adults? Special care is required in prescribing and monitoring drug therapy for older patients with diabetes. Metformin has traditionally been considered contraindicated when the eGFR is < 60 mL/min; however, recent studies have shown that metformin can be used safely in …