Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- diarreia aquosa profusa
Outros fatores diagnósticos
- aproximadamente 50 anos de idade
- cefaleia
- perda de peso
- turgor cutâneo diminuído
- membranas mucosas ressecadas
- fraqueza muscular
- cãibras musculares
- sintomas gastrointestinais
- sintomas de hiperglicemia
- rubor
- hepatomegalia
- história de neoplasia endócrina múltipla tipo 1 (NEM1)
Fatores de risco
- neoplasia endócrina múltipla tipo 1 (NEM1)
- aproximadamente 50 anos de idade
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- potássio sérico
- bicarbonato sérico
- cálcio sérico
- glicose sérica
- radioimunoensaio do peptídeo intestinal vasoativo (PIV)
- testes da função hepática
Investigações a serem consideradas
- análise da gasometria arterial
- monitoramento do potencial hidrogeniônico (pH) gástrico
- cromogranina A
- polipeptídeo pancreático
- TC com contraste do abdome
- ressonância nuclear magnética (RNM) com contraste do abdome
- PET-TC/RNM com receptores da somatostatina
- cintilografia com receptores da somatostatina
- ultrassonografia endoscópica
- exploração cirúrgica
- ultrassonografia intraoperatória
- biópsia
Algoritmo de tratamento
apresentação inicial do paciente sintomático
doença localizada
Doença metastática: candidato a cirurgia
Doença metastática: não candidato a cirurgia
doença refratária
Colaboradores
Autores
Harish Lavu, MD, FACS
Professor of Surgery
Sidney Kimmel Medical College
Thomas Jefferson University
Philadelphia
PA
Declarações
HL declares that he has no competing interests.
Charles J. Yeo, MD, FACS
The Samuel D. Gross Professor and Chair
Department of Surgery
Sidney Kimmel Medical College
Thomas Jefferson University
Philadelphia
PA
Declarações
CJY declares that he has no competing interests.
Revisores
Alexandria Phan, MD
Professor of Medicine
Froedtert Hospital and the Medical College of Wisconsin
Milwaukee
WI
Declarações
AP declares that she has no competing interests.
Jonathan Strosberg, MD
Professor
Moffitt Cancer Center
Tampa
FL
Declarações
JS has consulted for Novartis and serves on the Speakers’ Bureau for Ipsen.
Jaime Ruiz-Tovar, MD
Fellow of the Spanish Association of Surgeons (AEC)
Department of Surgery
University Hospital Ramon y Cajal
Madrid
Spain
利益声明
JRT 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.
参考文献
关键文献
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: neuroendocrine and adrenal tumors [internet publication].全文
Hofland J, Falconi M, Christ E, et al. European Neuroendocrine Tumor Society 2023 guidance paper for functioning pancreatic neuroendocrine tumour syndromes. J Neuroendocrinol. 2023 Aug;35(8):e13318.全文 摘要
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.全文
Del Rivero J, Perez K, Kennedy EB, et al. Systemic therapy for tumor control in metastatic well-differentiated gastroenteropancreatic neuroendocrine tumors: ASCO guideline. J Clin Oncol. 2023 Nov 10;41(32):5049-67.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Gastroenterite infecciosa
- Diarreia osmótica
- Má absorção do ácido biliar ileal
更多 鉴别诊断指南
- NCCN clinical practice guidelines in oncology: neuroendocrine and adrenal tumors
- Symptom management for well-differentiated gastroenteropancreatic neuroendocrine tumors: ASCO guideline
更多 指南
登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容
内容使用需遵循免责声明