Endocrine Abstracts

Introduction: Neuroendocrine tumors are rare tumors with increasing incidence. They are characterized by the expression of proteins and hormonal products common to neurons and endocrine cells, and are often diagnosed at an advanced stage due to the delayed onset of nonspecific symptoms. We report the case of a patient who presented with a flush syndrome associated with a thyroid nodule and who was subsequently diagnosed with a digestive neuroendocrine tumor

Observation: A 60-year-old patient, chronic smoker, was admitted for a flush syndrome. The interrogation found liquid diarrhea at the rate of 5 stools per day, with palpitations and sweating for 1 year, dysphagia, without dysphonia, or dyspnea, slimming quantified at 14 kg over 15 days, asthenia and anorexia. The examination found a conscious patient, a BMI at 20 kg/m², bilateral malar erythema, slightly increased thyroid volume with palpation of a left nodule of 1 cm, slightly sensitive, hard, mobile, without vascular trill, a distended abdomen with hard epigastric mass, hard hepatomegaly, bilateral inguinal lymphadenopathy and edema of the lower limbs. Investigations showed hyperthyroidism with at the cervical ultrasound a multihetero nodular goiter classified TIRADS 3 and a negative calcitonin, thoraco-abdomino-pelvic CT showed duodenal lesion associated with ganglion masses, retractile mesenteritis, hepatic metastases and peritoneal carcinomatosis suggestive of a neuroendocrine tumor. Octreoscan showed a mass of D2 moderately fixing the product with liver metastases.

Discussion: NETs are rare tumors but must be evoked especially in the presence of symptoms indicating paraneoplastic endocrine secretions such as flush syndrome. The most frequent localizations are hailic, then bronchial, colic and gastric. Biologically, the diagnosis is based on the elevation of chromogranin A, blood serotonin and urinary 5-hydroxy-indol-acetic acid (5HIAA). Octreoscan may be useful for the diagnosis and tumor extension assessment. Certain factors favoring the triggering of a carcinoid syndrome are sometimes reported: diet, emotion, anesthesia, alcohol consumption, pentagastrin or catecholamine administration. The factors limiting or suppressing seizures are somatostatin, interferon alpha, antihistamines, alpha blockers, serotonin inhibitors and of course tumor resection.