Endocrine Abstracts

Aim: We had noted that certain patients with metastatic mid-gut carcinoid had subcutaneous nodules in the gluteal region. This prompted us to assess this in more detail as the concern was whether these represented metastases.

Method: A cross-sectional study was designed to assess CT scans of 56 patients with metastatic mid gut carcinoid attending the Neuroendocrine Tumour Clinic. These were analysed by two independent radiologists blinded as to the treatment status of the patients. The sample consisted of four different groups: Group A), 22 patients on somatostatin analogue X; Group B), twelve patients on somatostatin analogue B; Group C), nine patients who had received both treatments; and Group D), thirteen patients who had never received any somatostatin analogues. The study was approved as an institutional case notes review.

Results: A total of 29 patients (51.8%) were found to have nodules. Of these, 16/22 patients in Group A, 5/12 patients in Group B and 8/9 patients in Group C had nodules. None of the patients in Group D were found to have nodules. The presence of nodules was significantly associated with the total number of injections (P=0.024), and the number of weeks on treatment (P=0.022). Multiple linear regression analysis revealed that the successive use of either analogue significantly increases the possibility of developing nodules.

Conclusion: Patients with metastatic mid-gut carcinoid tumours on somatostatin analogues have large numbers of subcutaneous nodules in the gluteal area, in contrast to those not on such treatment. Nodules may occur when patients are on either analogue, but are more likely with use of Analogue X. This clear observation should give reassurance to those managing these patients that nodules such as these are unlikely to represent metastases. Moreover, detecting nodules could be of use in monitoring compliance in any patient opting to self-inject.