Differential Diagnosis and Management of Diarrhea in Patients with Neuroendocrine Tumors
Diarrhea is a recurrent symptom in patients with neuroendocrine tumors (NETs) and can represent different etiologies; thus, differential diagnosis is challenging. This paper distinguishes the different causes of chronic diarrhea in patients with gastroenteropancreatic NETs, with the aim to identify...
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-08-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/9/8/2468 |
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| author | Sara Pusceddu Roberta Elisa Rossi Martina Torchio Natalie Prinzi Monica Niger Jorgelina Coppa Luca Giacomelli Rodolfo Sacco Antonio Facciorusso Francesca Corti Alessandra Raimondi Michele Prisciandaro Elena Colombo Teresa Beninato Marta Del Vecchio Massimo Milione Maria Di Bartolomeo Filippo de Braud |
| author_facet | Sara Pusceddu Roberta Elisa Rossi Martina Torchio Natalie Prinzi Monica Niger Jorgelina Coppa Luca Giacomelli Rodolfo Sacco Antonio Facciorusso Francesca Corti Alessandra Raimondi Michele Prisciandaro Elena Colombo Teresa Beninato Marta Del Vecchio Massimo Milione Maria Di Bartolomeo Filippo de Braud |
| author_sort | Sara Pusceddu |
| collection | DOAJ |
| description | Diarrhea is a recurrent symptom in patients with neuroendocrine tumors (NETs) and can represent different etiologies; thus, differential diagnosis is challenging. This paper distinguishes the different causes of chronic diarrhea in patients with gastroenteropancreatic NETs, with the aim to identify the most appropriate therapeutic approach. Underlying causes of diarrhea can be multifactorial, including not only diarrhea that is related to specific hormonal hypersecretory syndromes, but also diarrhea that is secondary to the following: extensive surgery which can cause pancreatic exocrine insufficiency or short bowel syndrome, treatment with somatostatin analogs or other antineoplastic agents, and bile acid malabsorption. After initial management of diarrhea with general treatments (dietary modification, use of antidiarrheals), a proper differential diagnosis is necessary to treat patients with specific etiology-driven therapeutic approaches, such as somatostatin analogs, pancreatic enzyme replacement therapy, and tryptophan hydroxylase inhibitors. In conclusion, NETs should be considered in the differential diagnosis of patients suffering from chronic diarrhea, after the exclusion of more common etiologies. Furthermore, physicians should keep in mind that several different etiologies might be responsible for diarrhea occurrence in NET patients. A prompt diagnosis of the actual cause of diarrhea is necessary to guide the treatment and a multidisciplinary approach is mandatory. |
| first_indexed | 2024-03-10T18:03:31Z |
| format | Article |
| id | doaj.art-c10b0f9e679c4a78983ed1bce55add19 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T18:03:31Z |
| publishDate | 2020-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-c10b0f9e679c4a78983ed1bce55add192023-11-20T08:44:51ZengMDPI AGJournal of Clinical Medicine2077-03832020-08-0198246810.3390/jcm9082468Differential Diagnosis and Management of Diarrhea in Patients with Neuroendocrine TumorsSara Pusceddu0Roberta Elisa Rossi1Martina Torchio2Natalie Prinzi3Monica Niger4Jorgelina Coppa5Luca Giacomelli6Rodolfo Sacco7Antonio Facciorusso8Francesca Corti9Alessandra Raimondi10Michele Prisciandaro11Elena Colombo12Teresa Beninato13Marta Del Vecchio14Massimo Milione15Maria Di Bartolomeo16Filippo de Braud17Department of Medical Oncology, Gastro-entero-pancreatic and Neuroendocrine Unit 1, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, ItalyGastro-intestinal Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, ItalyDepartment of Medical Oncology, Gastro-entero-pancreatic and Neuroendocrine Unit 1, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, ItalyDepartment of Medical Oncology, Gastro-entero-pancreatic and Neuroendocrine Unit 1, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, ItalyDepartment of Medical Oncology, Gastro-entero-pancreatic and Neuroendocrine Unit 1, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, ItalyGastro-intestinal Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, ItalyPolistudium SRL, 20135 Milan, ItalyDepartment of Medical Sciences, Section of Gastroenterology, University of Foggia, 71122 Foggia, ItalyDepartment of Medical Sciences, Section of Gastroenterology, University of Foggia, 71122 Foggia, ItalyDepartment of Medical Oncology, Gastro-entero-pancreatic and Neuroendocrine Unit 1, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, ItalyDepartment of Medical Oncology, Gastro-entero-pancreatic and Neuroendocrine Unit 1, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, ItalyDepartment of Medical Oncology, Gastro-entero-pancreatic and Neuroendocrine Unit 1, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, ItalyDepartment of Medical Oncology, Gastro-entero-pancreatic and Neuroendocrine Unit 1, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, ItalyDepartment of Medical Oncology, Gastro-entero-pancreatic and Neuroendocrine Unit 1, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, ItalyUnit of Pharmacy, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, ItalyDepartment of Pathology and Laboratory Medicine, Fondazione IRCCS–Istituto Nazionale dei Tumori, 20133 Milan, ItalyDepartment of Medical Oncology, Gastro-entero-pancreatic and Neuroendocrine Unit 1, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, ItalyDepartment of Medical Oncology, Gastro-entero-pancreatic and Neuroendocrine Unit 1, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, ItalyDiarrhea is a recurrent symptom in patients with neuroendocrine tumors (NETs) and can represent different etiologies; thus, differential diagnosis is challenging. This paper distinguishes the different causes of chronic diarrhea in patients with gastroenteropancreatic NETs, with the aim to identify the most appropriate therapeutic approach. Underlying causes of diarrhea can be multifactorial, including not only diarrhea that is related to specific hormonal hypersecretory syndromes, but also diarrhea that is secondary to the following: extensive surgery which can cause pancreatic exocrine insufficiency or short bowel syndrome, treatment with somatostatin analogs or other antineoplastic agents, and bile acid malabsorption. After initial management of diarrhea with general treatments (dietary modification, use of antidiarrheals), a proper differential diagnosis is necessary to treat patients with specific etiology-driven therapeutic approaches, such as somatostatin analogs, pancreatic enzyme replacement therapy, and tryptophan hydroxylase inhibitors. In conclusion, NETs should be considered in the differential diagnosis of patients suffering from chronic diarrhea, after the exclusion of more common etiologies. Furthermore, physicians should keep in mind that several different etiologies might be responsible for diarrhea occurrence in NET patients. A prompt diagnosis of the actual cause of diarrhea is necessary to guide the treatment and a multidisciplinary approach is mandatory.https://www.mdpi.com/2077-0383/9/8/2468neuroendocrine tumorschronic diarrheaexocrine pancreatic insufficiencydifferential diagnosis |
| spellingShingle | Sara Pusceddu Roberta Elisa Rossi Martina Torchio Natalie Prinzi Monica Niger Jorgelina Coppa Luca Giacomelli Rodolfo Sacco Antonio Facciorusso Francesca Corti Alessandra Raimondi Michele Prisciandaro Elena Colombo Teresa Beninato Marta Del Vecchio Massimo Milione Maria Di Bartolomeo Filippo de Braud Differential Diagnosis and Management of Diarrhea in Patients with Neuroendocrine Tumors Journal of Clinical Medicine neuroendocrine tumors chronic diarrhea exocrine pancreatic insufficiency differential diagnosis |
| title | Differential Diagnosis and Management of Diarrhea in Patients with Neuroendocrine Tumors |
| title_full | Differential Diagnosis and Management of Diarrhea in Patients with Neuroendocrine Tumors |
| title_fullStr | Differential Diagnosis and Management of Diarrhea in Patients with Neuroendocrine Tumors |
| title_full_unstemmed | Differential Diagnosis and Management of Diarrhea in Patients with Neuroendocrine Tumors |
| title_short | Differential Diagnosis and Management of Diarrhea in Patients with Neuroendocrine Tumors |
| title_sort | differential diagnosis and management of diarrhea in patients with neuroendocrine tumors |
| topic | neuroendocrine tumors chronic diarrhea exocrine pancreatic insufficiency differential diagnosis |
| url | https://www.mdpi.com/2077-0383/9/8/2468 |
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