Health

Should all incidentally discovered adrenal masses be resected? No. Incidentally discovered, clinically occult adrenal masses, referred to as incidentalomas, are common (4.4% in modern abdominal computed tomography [CT] series) and increasingly encountered with the ubiquity of abdominal CT. Most incidentally discovered adrenal nodules are nonfunctional and benign (80% are cortical adenomas), requiring only surveillance. Adrenalectomy is indicated …

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principles of systemic therapy in patients with unresectable or metastatic NETs? There is no known role for adjuvant systemic therapy. Patients who have metastatic NETs and carcinoid syndrome should be treated with a somatostatin analogue (octreotide or lanreotide). The long-acting release (LAR) preparations are often effective for symptom management; intercurrent symptom flares can be treated …

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Role of surgery for liver metastases from neuroendocrine tumors (both pancreatic and nonpancreatic) Surgical resection is the recommended treatment for patients with liver metastases from intestinal NETs and/or PNETs. These patients experience symptomatic improvement and have prolonged survival (58%–70% versus 25%–30% 5-year survival rates) compared with similar patients who do not undergo hepatic resection. Patients …

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appropriate surgical management for non–PNETS (carcinoid tumors) Gastric carcinoids are classified into three types. Types I and II account for most gastric carcinoids (> 75%) and are associated with chronic hypergastrinemia resulting from chronic atrophic gastritis (type I) and ZES (type II), respectively. These tumors are most commonly small (< 1 cm) and multifocal and …

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Carcinoid syndrome Carcinoid syndrome refers to a group of symptoms that occur when NETs secrete large amounts of various humoral substances into the systemic circulation. The most common features are cutaneous flushing (85%–90%), secretory diarrhea (75%–80%), bronchospasm (10%–20%), and fibrotic growths involving the endocardium and right heart valves (33%) and sometimes pleural, peritoneal, or retroperitoneal fibrosis. …

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Presentation of nonpancreatic GI neuroendocrine tumors (carcinoid tumors) Carcinoid tumors can occur in many different organs throughout the body but most commonly occur in the GI tract (approximately 70% of the time). Within the GI tract, the most common locations, listed in descending order, are the small intestine, rectum, appendix, large intestine, and stomach. Neuroendocrine …

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Should PNETs occurring in patients with MEN 1 be approached differently from PNETs occurring sporadically? Yes. Approximately 70% of patients with MEN 1 develop PNETs, with gastrinoma being the most common. Gastrinomas are commonly multifocal in these patients and, thus, aggressive surgery is often necessary to achieve a biochemical cure; however, this is not routinely …

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