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Multiple, secondary hormone secretion in PNETs linked to morbidity, mortality
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A minority of patients display a diversity of pancreatic neuroendocrine tumor hormone secretion at tumor diagnosis or during the course of their disease.
These patients are at increased risk for morbidity and mortality and should be monitored for clinical symptoms of secondary hormone secretion during the disease course, according to study findings.
Joakim Crona, MD, PhD, of Uppsala University in Sweden, and colleagues evaluated 926 patients with small intestinal neuroendocrine tumors or pancreatic neuroendocrine tumors (PNETs) being treated at Uppsala University Hospital to determine the frequency and effect of multiple and secondary hormone secretion. Data were collected from 1985 to 2013 for PNETs and 1985 to 2010 for small intestine neuroendocrine tumors. Participants were divided into groups based on tumor type: small intestine (n = 603) and pancreatic (n = 323).
Nineteen patients in the PNET group had multiple hormone secretion at diagnosis, and 14 developed secondary hormone secretion during the disease course; no patient in the small intestine neuroendocrine tumor group had multiple hormone secretion, and only one showed secondary hormone secretion.
Multiple hormone secretion in patients in the PNET group was exclusive to those with metastatic disease, and there was a trend toward shorter survival (median, 56 months) compared with those with single hormone secretion (median, 143 month; log-rank test P = .124). More participants with multiple hormone secretion at diagnosis developed secondary hormone secretion (16%) compared with those without multiple hormone secretion (5%) or those with a single elevated hormone (3%).
The median time from diagnosis of PNET to secondary hormone secretion was 53.5 months with an 18.5-month median survival from the detection of secondary secretion. Survival duration from the time of detection was shorter in those with secondary insulin secretion (median, 10 months) compared with those with other secondary hormones (median, 31 months).
“We have demonstrated that multiple and secondary hormone secretion occurs in a minor proportion (9.3%) of PNET patients, and were restricted to patients with metastatic disease,” the researchers wrote. “Secondary hormone secretion was associated with disease progression as well as increased morbidity and mortality. Our results support that patients with metastatic PNETs should be monitored for the appearance of clinical symptoms of secondary hormone secretion during the disease course, whereas those with [small intestinal neuroendocrine tumors] should be investigated in the presence of exceptional symptoms.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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