This chapter covers endocrine cancers, including typical thyroid cancer as well as medullary thyroid carcinoma (MTC). Adrenal tumours, associated with Cushing's syndrome, and Conn's syndrome, associated with pituitary tumours, are discussed in detail. It includes information on epidemiology, clinical features, pathology, diagnosis, treatment, follow-up, and prognosis. It also covers special problems in pregnancy. Special attention is made to merging techniques in molecular oncology, which have led to biomarker-driven therapy of thyroid and pancreatic neuroendocrine tumours with biologic agents. For pancreatic neuroendocrine tumours, special attention is made to new imaging techniques and therapy for patients with syndrome associated with peptide hormone release.
Small non-functioning pancreatic NETs (pNETs) ≤2 cm can pose a management dilemma in terms of surveillance or resection. There is evidence to suggest that a surveillance approach can be considered since there are no significant radiological changes observed in lesions during long-term follow-up. However, other studies have suggested loco-regional spread can be present in ≤2 cm pNETs. The aim of this study was to characterise the prevalence of malignant features and identify any useful predictive variables in a surgically resected cohort of pNETs. 418 patients with pNETs were identified from 5 NET centres. Of these 227 were included for main analysis of tumour characteristics. Mean age of patients was 57 years, 47% were female. The median follow-up was 48.2 months. Malignant features were identified in 38% of ≤2 cm pNETs. ROC analysis showed that the current cut-off of 20 mm had a sensitivity of 84% for malignancy. The rate of malignant features is in keeping with other surgical series and challenges the belief that small pNETs have a low malignant potential. This study does not support a 20 mm size cut-off as being a solitary safe parameter to exclude malignancy in pNETs.
SummaryRadioisotope renograms were obtained in the upright and prone position in 9 normal subjects, in 5 patients with untreated essential hypertension and in 21 hypertensives under treatment, showing moderate postural hypotension.No significant renographic change were seen in the two positions in normal subjects and untreated hypertensives. Treated hypertensives with postural hypotension showed significant impairment of renal function in the upright position in 15 cases and no change in 6. Renal creatinine clearance was lower in the group that showed renographic changes. Renography in the upright position is suggested as a convenient test for early diagnosis and follow-up of the adverse effects of antihypertensive treatment.
IIntroduction:
Pancreatic Neuroendocrine Tumours (p-NETs) are an important disease entity
and comprise of peptide-secreting tumours often with a functional syndrome.
:
Accounting for a small percentage of all pancreatic tumours, they have a good overall survival rate
when diagnosed early, with surgery being curative. The role of nuclear medicine in the diagnosis and
treatment of these tumours is evident. However, the vast majority of patients will require extensive imaging
in the form of conventional radiological techniques. It is important for clinicians to have a fundamental
understanding of the p-NET appearances to aid prompt identification and to help direct management
through neoplastic staging.
Methods:
This article will review the advantages and disadvantages of conventional radiological techniques
in the context of p-NETs and highlight features that these tumours exhibit.
Conclusion:
Pancreatic neuroendocrine tumours are a unique collection of neoplasms that have markedly
disparate clinical features but similar imaging characteristics. Most p-NETs are small and welldefined
with homogenous enhancement following contrast administration, although larger and less welldifferentiated
tumours can demonstrate areas of necrosis and cystic architecture with heterogeneous
enhancement characteristics.
:
Prognosis is generally favourable for these tumours with various treatment options available. However,
conventional radiological techniques will remain the foundation for the initial diagnosis and staging of
these tumours, and a grasp of these modalities is extremely important for physicians.
Utility of chromogranin A, pancreatic polypeptide, glucagon and gastrin in the diagnosis and follow-up of pancreatic neuroendocrine tumours in multiple endocrine neoplasia type 1 patients
