Resumo
Definição
History and exam
Key diagnostic factors
- presença de fatores de risco
- úlcera péptica refratária ou recorrente
- diarreia
Other diagnostic factors
- dor abdominal epigástrica
- doença do refluxo gastroesofágico
- esteatorreia
- hemorragia digestiva
- dor óssea
Risk factors
- neoplasia endócrina múltipla tipo 1 (NEM1)
Diagnostic investigations
1st investigations to order
- gastrina sérica em jejum
- pH gástrico
Investigations to consider
- teste de estimulação de secretina
- teste de infusão de cálcio
- teste do glucagon
- tomografia computadorizada (TC) abdominal
- ressonância nuclear magnética (RNM) abdominal
- cintilografia dos receptores da somatostatina (CRS)
- PET com Gálio (Ga)-68 DOTATATE
- ultrassonografia endoscópica (USE)
- endoscopia digestiva alta (EDA)
- tomografia computadorizada (TC) do tórax
- teste genético para neoplasia endócrina múltipla tipo 1 (NEM1)
Treatment algorithm
doença localizada: esporádica
Doença localizada: NEM1
doença metastática: predominantemente hepática
doença metastática: extra-hepática
Contributors
Authors
Joseph R. Pisegna, MD
Professor of Medicine
Chief
Division of Gastroenterology, Hepatology, and Parenteral Nutrition
David Geffen School of Medicine at University of California
VA Greater Los Angeles Healthcare System
Department of Veterans Affairs
Los Angeles
CA
Disclosures
JRP is an author of a number of references cited in this topic. JRP has received a grant from Takeda Pharmaceuticals and is a speaker for Phathom Pharmaceuticals and AbbVie.
Acknowledgements
Dr Joseph R. Pisegna would like to gratefully acknowledge Dr Deepinder Goyal, Dr Jihane Benhammou, Dr David Oh, and Dr Hank Wang, previous contributors to this topic.
Disclosures
DG, JB, DO, and HW declare that they have no competing interests.
Peer reviewers
Peter Draganov, MD
Associate Professor of Medicine Division
Gastroenterology, Hepatology and Nutrition
University of Florida
Gainesville
FL
Disclosures
PD declares that he has no competing interests.
Petros Perros, BSc, MBBS, MD, FRCP
Consultant Endocrinologist
Freeman Hospital
Newcastle-Upon-Tyne Hospitals Trust
UK
Disclosures
PP declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Falconi M, Eriksson B, Kaltsas G, et al. ENETS consensus guidelines update for the management of patients with functional pancreatic neuroendocrine tumors and non-functional pancreatic neuroendocrine tumors. Neuroendocrinology. 2016;103(2):153-71.Full text Abstract
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: neuroendocrine and adrenal tumors [internet publication].Full text
Pavel M, Öberg K, Falconi M, et al. Gastroenteropancreatic neuroendocrine neoplasms: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2020 Jul;31(7):844-60.Texto completo Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
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