Gastroesophageal tube of the Iguana iguana (Iguanidae): histological description, histochemical and immunohistochemical analysis of 5-HT and SS cells / Tubo gastroesofágico da Iguana iguana (Iguanidae): descrição histológica, histoquímica e análise imunohistoquímica de células 5-HT e SS

The work aims were to describe the histological and histochemical structure of the gastroesophageal tube of Iguana iguana and verify the occurrence and distribution of immunoreactive serotonin (5-HT) and somatostatin (SS) cells. Fragments of the gastrointestinal tract (GIT) of five iguanas were which underwent standard histological and immunohistochemistry technique. Immunoreactive cells for 5-HT and SS were quantified using the STEPanizer. The oesophagus has ciliated columnar pseudostratified epithelium with staining Alcian blue (AB) + and goblet cells highly reactive to periodic acid Schiff (PAS). In the cervical oesophagus, the numerical density of 5-HT cells per unit area (QA [5-HT cells]/µm2) was 4.6x10-2 ± 2.0 and celomatic oesophagus presented QA = 4.0x10-2 ± 1.0. The epithelium of the stomach is simple columnar, PAS and AB +. The cranial and middle regions of the stomach presented (QA [5-HT cells]/µm2) = 6.18x10-2 ± 3.2 and the caudal region, QA = 0.6x10-2 ± 0.2. The SS cells were only observed in the caudal stomach, with numerical density (QA [SS cells]/µm2) = 1.4x10-2 ± 0.9 In I. iguana, variation was observed in terms of the distribution of mucus secretions and the pattern of occurrence of serotonin and somatostatin-secreting enteroendocrine cells in the TGI, which possibly will result in an interspecific adaptive response.

Os objetivos do trabalho foram descrever a estrutura histológica e histoquímica do tubo gastroesofágico da Iguana iguana e verificar a ocorrência e distribuição de células serotonina (5-HT) e somatostatina (SS) imunorreativas. Fragmentos do trato gastrointestinal (TGI) de cinco iguanas foram submetidos à técnica histológica e imunohistoquímica padrão. As células imunorreativas para 5-HT e SS foram quantificadas usando o STEPanizer. O esôfago apresenta epitélio pseudoestratificado colunar ciliado Alcian blue (AB) positivo, com células caliciformes altamente reativas ao ácido periódico de Schiff (PAS). No esôfago cervical, a densidade numérica de células 5-HT por unidade de área (QA [células 5-HT] / µm2) foi de 4.6x10-2 ± 2.0 e o esôfago celomático apresentou QA = 4.0x10-2 ± 1.0. O epitélio do estômago é colunar simples, PAS e AB positivo. As regiões cranial e média do estômago apresentaram (QA [células 5-HT] / µm2) = 6.18x10-2 ± 3.2 e a região caudal, QA = 0.6x10-2 ± 0.2. As células SS foram observadas apenas no estômago caudal, com densidade numérica (QA [células SS] / µm2) = 1.4x10-2 ± 0.9. Em I. iguana, foi observada variações em termos da distribuição das secreções de muco e padrão de ocorrência das células enteroendócrinas secretoras de serotonina e somatostatina no TGI, o que possivelmente reflete uma resposta adaptativa interespecifica.

Somatostatin-Positive Neurons in the Rostral Zona Incerta Modulate Innate Fear-Induced Defensive Response in Mice / 神经科学通报·英文版

Defensive behaviors induced by innate fear or Pavlovian fear conditioning are crucial for animals to avoid threats and ensure survival. The zona incerta (ZI) has been demonstrated to play important roles in fear learning and fear memory, as well as modulating auditory-induced innate defensive behavior. However, whether the neuronal subtypes in the ZI and specific circuits can mediate the innate fear response is largely unknown. Here, we found that somatostatin (SST)-positive neurons in the rostral ZI of mice were activated by a visual innate fear stimulus. Optogenetic inhibition of SST-positive neurons in the rostral ZI resulted in reduced flight responses to an overhead looming stimulus. Optogenetic activation of SST-positive neurons in the rostral ZI induced fear-like defensive behavior including increased immobility and bradycardia. In addition, we demonstrated that manipulation of the GABAergic projections from SST-positive neurons in the rostral ZI to the downstream nucleus reuniens (Re) mediated fear-like defensive behavior. Retrograde trans-synaptic tracing also revealed looming stimulus-activated neurons in the superior colliculus (SC) that projected to the Re-projecting SST-positive neurons in the rostral ZI (SC-ZIrSST-Re pathway). Together, our study elucidates the function of SST-positive neurons in the rostral ZI and the SC-ZIrSST-Re tri-synaptic circuit in mediating the innate fear response.

Effect of somatostatin on postoperative gastrointestinal function and stress level in children with acute abdomen: a prospective randomized controlled study / 中国当代儿科杂志

OBJECTIVES@#To study the effect of somatostatin on postoperative gastrointestinal function and stress level in children with acute abdomen.@*METHODS@#A total of 102 children with acute abdomen who underwent surgery in Xuzhou Children's Hospital from August 2019 to June 2021 were enrolled as subjects and were randomly divided into an observation group and a control group, with 51 children in each group. The children in the control group were given conventional treatment such as hemostasis and anti-infective therapy after surgery, and those in the observation group were given somatostatin in addition to conventional treatment. Peripheral blood samples were collected from both groups before surgery and on days 1 and 5 after surgery. The two groups were compared in terms of the serum levels of endothelin-1 (ET-1), adrenocorticotropic hormone (ACTH), cortisol, gastrin, and motilin, postoperative recovery, and the incidence rate of complications.@*RESULTS@#There was no significant difference in the serum levels of ET-1, ACTH, cortisol, gastrin, and motilin between the two groups before surgery (P>0.05). Compared with the control group, the observation group had significantly lower serum levels of ET-1, ACTH, and cortisol on days 1 and 5 after surgery (P<0.05) and significantly higher levels of motilin and gastrin on day 5 after surgery (P<0.05). Compared with the control group, the observation group had significantly shorter time to first passage of flatus, first bowel sounds, and first defecation after surgery, as well as a significantly shorter length of hospital stay (P<0.05). The incidence rate of complications in the observation group was significantly lower than that in the control group (6% vs 24%, P<0.05).@*CONCLUSIONS@#In children with acute abdomen, somatostatin can significantly reduce postoperative stress response, improve gastrointestinal function, and reduce the incidence rate of complications, thereby helping to achieve a good prognosis.

Effects of exogenous ghrelin on the tissue structure and somato-statin secretion in the pancreas of African ostrich chicks / Efectos de la grelina exógena en la estructura del tejido y la secreción de somato-estatinas en el páncreas de los polluelos de avestruz africanos

SUMMARY: This study aimed to investigate the effect of exogenous ghrelin on pancreatic growth and development in African ostrich chicks. Sixteen 40-day-old African ostrich chicks (male or female) were randomly divided into four groups and injected intravenously metatarsal vein with saline (control) or ghrelin (10, 50, and 100 μg/kg) for 6 days. Body and pancreas weight were determined, structural characteristics were observed using HE staining, somatostatin-immunopositive cells were detected using immunohistochemistry. The results were as follows: 1. The 50 and 100 μg/kg groups showed lower relative pancreas weight than the control group (P 0.05. Moreover, compared with the control, the islet cells in treatment groups were loosely arranged and showed reduced cytoplasm. In the exocrine pancreas, the volume of acinar cells in the 10, 50, and 100 μg/kg groups all decreased to varying degrees. 3. Somatostatin immunopositive cells were mainly located around the periphery of the islets and sporadically distributed in the center. The density of the somatostatin immunopositive cells in the 10, 50, and 100 μg/kg groups was higher than that in the control (P < 0.05). These findings suggest that exogenous ghrelin increases the area and number of islets and number of somatostatin immunopositive cells but reduces relative pancreas weight and effects the morphological and structural development of the pancreas, which may inhibit the pancreatic growth and development in African ostrich chicks.

RESUMEN: Este estudio tuvo como objetivo investigar el efecto de la grelina exógena sobre el crecimiento y desarrollo del páncreas en polluelos de avestruz africana. Dieciséis pollos de avestruz africana de 40 días (machos o hembras) se dividieron al azar en cuatro grupos y se inyectaron por vía intravenosa con solución salina (control) o grelina (10, 50 y 100 μg / kg) durante 6 días. determinadas, se observaron las características estructurales mediante tinción Hematoxilina-Eosina, se detectaron células inmunopositivas a somatostatina mediante inmunohistoquímica. Los resultados fueron los siguientes: ¨Los grupos de 50 y 100 μg / kg mostraron un menor peso relativo del páncreas que el grupo de control (P <0,05). El área de islotes por unidad de área del páncreas fue mayor en los grupos de 10, 50 y 100 μg / kg grupos que en el grupo de control (P <0,05). El número de islotes por unidad de área del páncreas fue menor en el grupo de 10 μg / kg que en el control (P <0,05). Además, en comparación con el control, las células de los islotes en los grupos de tratamiento estaban dispuestas de forma holgada y mostraban un citoplasma reducido. En el páncreas exocrino, el volumen de células acinares en los grupos de 10, 50 y 100 μg / kg disminuyó en diversos grados. Las células inmunopositivas de somatostatina se ubicaron principalmente alrededor de la periferia de los islotes y se distribuyeron esporádicamente en el centro. La densidad de las células inmunopositivas a la somatostatina en los grupos de 10, 50 y 100 μg / kg fue mayor que la del control (P <0,05). Estos hallazgos sugieren que la grelina exógena aumenta el área y el número de islotes y el número de células inmunopositivas a la somatostatina, pero reduce el peso relativo del páncreas, lo que puede inhibir el crecimiento y desarrollo pancreático en los polluelos de avestruz africana.

Tratamiento conservador del quilotórax posquirúrgico en paciente pediátrico / Conservative treatment of post-surgical chylothorax in pediatric patient

INTRODUCCIÓN. El quilotórax resulta de un daño al conducto torácico por ruptura, laceración, desgarro o compresión. Es una patología rara de derrame pleural en la edad pediátrica, pero frecuente como complicación posterior a cirugía cardiotorácica. La base del tratamiento conservador se ha fundamentado en: drenaje inicial, modificación de la dieta, uso de somatostatina o análogos sintéticos como octreotide, cirugía, prevención y manejo de complicaciones. Fue preciso describir la experiencia institucional clínica así como su abordaje. CASO CLÍNICO. Paciente masculino de 4 meses de edad, que ingresó a la Unidad Pediátrica Área de Emergencias del Hospital de Especialidades Carlos Andrade Marín, el 13 de septiembre de 2019 con antece-dente quirúrgico de atresia de esófago corregida en etapa neonatal. Acudió con dificultad respiratoria, radiografía de tórax que evidenció derrame pleural derecho, toracentesis diagnóstica con salida de líquido de aspecto turbio y lechoso; se colocó tubo de tórax derecho. Se prescribió ayuno inicial, nutrición parenteral durante 4 semanas hasta comprobar resolución del quilotórax. Fue dado de alta en condición estable tras 43 días de hospitalización. DISCUSIÓN. La evidencia científica registró que el tratamiento conservador del quilotórax se basó en: drenaje, reposo digestivo inicial, nutrición parenteral, modificación cualitativa de la dieta enteral y uso de octreotide; el mismo que fue aplicado al paciente de este caso clínico con evolución favorable. CONCLUSIÓN. El tratamiento conservador y multidisciplinario en el abordaje del qui-lotórax fue exitoso y no necesitó manejo quirúrgico.

INTRODUCTION. Chylothorax results from damage to the thoracic duct by rupture, la-ceration, tear or compression. It is a rare pathology of pleural effusion in pediatric age, but frequent as a complication after cardiothoracic surgery. The basis of conservative treatment has been based on: initial drainage, diet modification, use of somatostatin or synthetic analogues such as octreotide, surgery, prevention and management of complications. It was necessary to describe the clinical institutional experience as well as its approach. CLINICAL CASE. A 4-month-old male patient was admitted to the Emergency Area Pediatric Unit of the Carlos Andrade Marín Specialties Hospital on september 13, 2019 with a surgical history of esophageal atresia corrected in the neonatal stage. He went with respiratory distress, chest X-ray that showed right pleural effusion, diagnostic thoracentesis with outflow of cloudy and milky fluid; a right chest tube was placed. Initial fasting was prescribed, parenteral nutrition for 4 weeks until resolution of the chylothorax was verified. He was discharged in stable condition after 43 days of hospitalization. DISCUSSION. The scientific evidence recorded that the conservative treatment of chylothorax was based on: drainage, initial digestive rest, parenteral nutrition, qualitative modification of enteral diet and use of octreotide; the same that was applied to the patient of this clinical case with favorable evolu-tion. CONCLUSION. Conservative and multidisciplinary treatment in the approach to chylothorax was successful.

Tumores Neuroendocrinos: un desafío transversal / Update on neuroendocrine tumors

Neuroendocrine Tumors (NETs) encompass a wide variety of tumors arising from neuroendocrine cells, which produce bioactive substances. The incidence of NETs increased significantly lately, becoming one of the most common tumors of the digestive tract. Their clinical presentation is as diverse as their capacity for hormone production. Carcinoid syndrome is the most common hormonal syndrome produced by NETs and is characterized by diarrhea, flushing and cardiac valvular lesions. New research brought multiple changes in the classification of these neoplasms and a new understanding about their diagnosis and treatment, promoting a multidisciplinary approach. Somatostatin analogues, radiation, biological, and cytotoxic drugs have improved the prognosis of these patients, which entails a great challenge for healthcare providers.

Cirugía radioguíada con análogos de somatostatina radiomarcados en tumores neuroendocrinos: reporte de caso / Radioguided surgery with radiolabeled somatostatin analogues in neuroendocrine tumors: Case report

Resumen Introducción: El mejor tratamiento para los tumores neuroendocrinos es la resección completa del tumor, los ganglios, e inclusive en casos seleccionados, las metástasis a distancia. En ocasiones, el tumor primario es pequeño y de difícil localización preoperatoria o sus recaídas pueden ser difíciles de localizar en el terreno de fibrosis por cirugías o tratamientos previos. La cirugía radioguíada ofrece una opción adicional de localización intraoperatoria que hasta ahora no ha sido muy utilizada en tumores neuroendocrinos. Presentación del caso: Paciente de 59 años con antecedente de resección atípica de duodeno y páncreas por tumor neuroendocrino grado 2 del duodeno un año antes. En la tomografía por emisión de positrones/tomografía computarizada (PET/CT) 68Ga-DOTANOC se encontró un ganglio con sobreexpresión de receptores de somatostatina en el mesenterio, sin otras lesiones a distancia. Por los antecedentes quirúrgicos y la dificultad de visualizar la lesión en las imágenes anatómicas (resonancia magnética [RM]) se decidió realizar la cirugía radioguíada. En el preoperatorio se administraron 15 mCi de tecnecio 99 metaestable-hidrazinonicotinilo-Tyr3-octreotida (99mTc-HYNIC-TOC) y se verificó la buena captación en el ganglio. En cirugía, luego de la disección inicial se utilizó la sonda gamma, que detectó una actividad 5 veces mayor en el ganglio, comparado con los tejidos vecinos, lo que permitió su localización y resección. La evolución fue adecuada y un año después no hay evidencia de recaídas. Conclusión: La cirugía radioguíada no ha sido muy utilizada en la localización intraoperatoria de tumores neuroendocrinos, pero es una buena alternativa en casos seleccionados, como el presentado en este artículo, y permite la detección intraoperatoria y su resección completa.

Abstract Introduction: The best treatment for neuroendocrine tumors is complete resection of the tumor, lymph nodes, and even distant metastases in selected cases. Sometimes, the primary tumor is small and difficult to detect before surgery, or its relapses may be difficult to locate in the fibrosis field due to previous surgeries or treatments. Although radioguided surgery allows for additional intraoperative localization, it has yet to be widely used in neuroendocrine tumors. Case report: A 59-year-old patient with a history of atypical resection of duodenum and pancreas due to grade 2 neuroendocrine tumor of the duodenum one year earlier. On 68Ga-DOTANOC PET/CT, a node with somatostatin receptor overexpression was found in the mesentery, with no other distant lesions. Due to the surgical history and the difficulty in visualizing the lesion on anatomical images (MRI), it was decided to perform the radioguided surgery. During the preoperative period, 15 mCi of 99mTc-HYNIC-TOC were administered verifying good uptake in the ganglion. Following the initial dissection, a gamma probe was used, detecting 5 times more activity in the ganglion than in adjacent tissues, allowing for localization and resection. The patient's progress was satisfactory, and one year later there is no evidence of relapse. Conclusion: Although radioguided surgery is not commonly used in the intraoperative location of neuroendocrine tumors, it is a viable option in some situations, such as the one presented here, because it allows for intraoperative detection and full resection.

Cortical 5-hydroxytryptamine receptor 3A (Htr3a) positive inhibitory neurons: diversity in type and function / 生理学报

Cortical GABAergic inhibitory neurons are composed of three major classes, each expressing parvalbumin (PV), somatostatin (SOM) and 5-hydroxytryptamine receptor 3A (Htr3a), respectively. Htr3a

Análogos de somatostatina radiomarcados en el acercamiento diagnóstico del síndrome de Sjögren: Imágenes moleculares aportando a los criterios clínicos y paraclínicos hoy conocidos / Radiolabelled somatostatin analogues in the diagnostic approach to Sjögren's syndrome: molecular imaging contributing to the current clinical and para-clinical criteria

RESUMEN El diagnóstico del síndrome de Sjögren se basa en los criterios del consenso americano y europeo (AECG), sin embargo, en muchas oportunidades no se alcanza a detectar el compromiso glandular o extraglandular. Presentamos la evidencia de la utilidad de la gammagrafía con los análogos de somatostatina radiomarcados como prueba novedosa en el acercamiento diagnóstico al compromiso glandular y extraglandular del síndrome de Sjögren.

ABSTRACT Sjögren syndrome is diagnosed using American European Consensus Group (AECG) criteria, although frequently these criteria are not enough to detect the glandular and extra-glandular compromise. Evidence is presented on the use of whole body somatostatin scintigraphy as a novel probe in the diagnostic approach to the glandular and extra-glandular compromise in Sjögren s syndrome.

Therapeutic Effect of a Novel Chimeric Molecule Targeting Both Somatostatin and Dopamine Receptors on Growth Hormone-Secreting Pituitary Adenomas

BACKGROUND: Acromegaly is a rare disease primarily caused by growth hormone (GH)-secreting pituitary adenomas, and its treatment is costly. Moreover, some patients are unresponsive to treatment. Hence, there are increasing efforts to develop new drugs with improved effectiveness for this disease. BIM23B065 is a novel chimeric molecule that acts on both somatostatin and dopamine receptors. This study aimed to investigate the effects of BIM23B065 compared with those of a somatostatin receptor analog and a dopamine agonist.METHODS: The effects of BIM23B065 on the proliferation, GH and insulin-like growth factor-1 (IGF-1) levels, and extracellular signal-regulated kinase (ERK) 1/2 and cyclic AMP response element binding (CREB) phosphorylation of GH3 cells were investigated with MTS assay, enzyme-linked immunosorbent assay, and Western blotting, respectively. The dosage and treatment duration of BIM23B065 were tested in animal models of GH-secreting pituitary adenoma. The effect of BIM23B065 (3 mg/kg/day) on changes in IGF-1 levels before and after treatment was further investigated.RESULTS: In vitro, BIM23B065 treatment decreased GH release in the culture media and downregulated ERK 1/2 and CREB phosphorylation to 22% and 26%, respectively. In vivo, IGF-1 expression decreased to 50 % after 4 weeks of treatment with BIM23B065 using an osmotic pump implant. Moreover, magnetic resonance imaging results showed that the tumor size decreased significantly following treatment with BIM23B065 for 4 weeks.CONCLUSION: The novel chimeric molecule was effective in decreasing IGF-1 and GH levels and may serve as an effective therapeutic agent for acromegaly.

Mu-opioid receptors in the paraventricular nucleus regulate ejaculatory behaviors via the sympathetic nerve system in male rats / 中华男科学杂志

Objective@#To explore the effects of the mu-opioid receptor (MOR) in the paraventricular nucleus (PVN) on the ejaculatory behaviors of male rats and its potential mechanisms.@*METHODS@#Male SD rats with normal ejaculation ability were mated with female ones in hormone-induced estrus. After bilateral PVN microinjection of D-Ala-2-Me-Phe-4-Gly-ol enkephalin (DAGO) or D-Phe-Cys-Tyr-D-Trp-Arg-Thr-Pen-Thr-NH2 (CTAP) with an inserted catheter, the male animals were observed for mount latency (ML), mount frequency (MF), intromission latency (IL), intromission frequency (IF), ejaculation latency (EL), ejaculation frequency (EF), post-ejaculation interval (PEI), and intromission ratio (IR). The lumbar sympathetic nerve activity (LSNA) of the rats was recorded using the PowerLab data acquisition hardware device, and the levels of norepinephrine (NE) in the peripheral plasma were measured by ELISA following microinjection of saline or different doses of DAGO or CTAP.@*RESULTS@#Neither CTAP nor DGAO significantly affected the ML of the male rats (P > 0.05). DGAO remarkably increased IF (P < 0.01) and MF (P < 0.01), prolonged IL (P < 0.01), EL (P < 0.01) and PEI (P < 0.01), and reduced EF (P <0.01) and IR (P < 0.05). On the contrary, CTAP markedly decreased IF (P < 0.01) and MF (P < 0.01), shortened IL (P < 0.01), EL (P < 0.01) and PFI (P < 0.01), and elevated EF (P < 0.01) and IR (P < 0.01). Additionally, DAGO decreased LSNA in a dose-dependent manner and reduced the NE level in the peripheral plasma. CTAP, however, not only offset the effects of DAGO on LSNA, but also significantly increased LSNA.@*CONCLUSIONS@#MOR in PVN inhibits ejaculatory behaviors in male rats by weakening LSNA, which has provided some theoretical evidence for the use of highly selective opioids in the treatment of premature ejaculation.

The position of combined medical treatment in acromegaly

ABSTRACT Advances in combination medical treatment have offer new perspectives for acromegaly patients with persistent disease activity despite receiving the available medical monotherapies. The outcomes of combination medical treatment may reflect both additive and synergistic effects. This review focuses on combination medical treatment and its current position in acromegaly, based on clinical studies evaluating the efficacy and safety of combined medical treatment(s) and our own experiences with combination therapy. Arch Endocrinol Metab. 2019;63(6):646-52

Pegvisomant in acromegaly: a multicenter real-life study in Argentina

ABSTRACT Objective To describe the long term safety and efficacy of pegvisomant (PEGV), and the predictors of treatment response in patients with acromegaly in the real life setting. Subjects and methods We retrospectively reviewed the clinical, hormonal and radiological data of acromegalic patients treated with PEGV in 17 Argentine centers. Results Seventy-five patients (age range 22-77, 51 females) with acromegaly have been treated with PEGV for up to 118 months (median 27 months). Before PEGV, 97.3% of patients had been treated with medical therapy, surgery and/or radiotherapy, two patients had no previous treatment. At that time, all patients had an IGF-1 above the upper normal limit (ULN) (mean 2.4 x ULN ± 0.98, range 1.25-7). At diagnosis of acromegaly 84% presented macroadenomas, prior to PEGV only 23,5% of patients remained with tumor remnant > 1 cm, the remaining showed normal or less than 1 cm images. Disease control (IGF-1 ≤ 1.2 x ULN) was achieved in 62.9% of patients with a mean dose of 11.8 mg/day. Thirty-four patients (45%) received PEGV monotherapy, while 41 (55%) received combined therapy with either somatostatin analogues and/or cabergoline. Adverse events related to PEGV were: local injection site reaction in 5.3%, elevated liver enzymes in 9.3%, and tumor size growth in 9.8%. Pre-PEGV IGF-I level was the only predictor of treatment response: 2.1 x ULN vs 2.8 x ULN in controlled and uncontrolled patients respectively (p < 0.001). Conclusion this long term experience indicates PEGV treatment was highly effective and safe in our series of Argentine patients with acromegaly refractory to standard therapies. Arch Endocrinol Metab. 2019;63(4):320-7

Hallazgos en gammagrafía con análogos de la somatostatina (Tc-99m HYNIC-TOC) en metástasis sobre cuero cabelludo como debut en un tumor neuroendocrino de origen incierto / Findings insomatostatin analogue scintigraphy (99mtc-HYNIC-TOC) in scalp metastasis as debut in a neuroendocrine tumor of uncertain origin / Achados em cintilografia com análogos de somatostatina (Tc-99m HYNIC-TOC) em metástases no couro cabeludo como estréia em um tumor neuroendócrino de origem incerta

Los estudios de medicina nuclear permiten en tumor neuroendocrino (TNE) de origen desconocido la búsqueda del tumor primario y estadificación de la enfermedad

Nuclear medicine studies allow neuroendocrine tumor (NET) of unknown origin to search for the primary tumor and staging the disease

Estudos de medicina nuclear permitem o tumor neuroendócrino (NET) de origem desconhecida para a pesquisa do tumor primário e o estadiamento da doença

Recent Updates in the Management of Advanced Pancreatic Neuroendocrine Tumors / 대한소화기학회지

Pancreatic neuroendocrine tumors (pNETs) are rare neoplasms arising from the pancreatic islet of Langerhans and can be functioning or non-functioning based on the clinical symptoms caused by hormonal secretions. PNETs are the second most common tumor of the pancreas and represent 1–2% of all pancreatic neoplasms. The incidence of pNETs appears to be rising and the prognosis seems to be improving, likely due to the improved treatment options. Recent updates of the World Health Organization classification and grading separate pNETs into 2 broad categories according to the histopathologic criteria, including the Ki-67 proliferative index and mitotic counts: well-differentiated NET and poorly-differentiated neuroendocrine carcinoma (NEC). The classification also incorporates a new subcategory of well-differentiated high-grade NEC (grade 3) to the well-differentiated NET category. This new classification algorithm aims to improve the prediction of the clinical outcomes and survival and help clinicians select better therapeutic strategies for patient care and management. The treatment of advanced or metastatic pNETs may include surgical resection, liver-directed therapies, and/or systemic treatments. In unresectable patients, the goals of these therapies are to palliate the tumor-related symptoms and prolong the lifespan. Systemic therapy consists of the following broad modalities: somatostatin analogues, molecular targeted therapy, systemic chemotherapy, and peptide receptor radionuclide therapy. In conclusion, pNETs are diagnosed increasingly throughout the world, usually with metastatic disease and requiring systemic therapy. Each patient should be evaluated thoroughly and discussed individually by a multidisciplinary and dedicated NET-expert team, which might consider all treatment options, including ongoing clinical trials before selecting the appropriate treatment sequence.

Medical Treatment with Somatostatin Analogues in Acromegaly: Position Statement / 대한내과학회지

Acromegaly is a chronic disorder caused by excessive growth hormone (GH) secretion. In most cases, the excess GH originates from GH-producing pituitary adenomas. Surgery is the preferred first-line treatment for patients with acromegaly, but medical management is considered when the disease persists after surgery or in cases where patients refuse surgery or are poor candidates for surgery. Somatostatin analogues are commonly used to treat acromegaly. The Korean Endocrine Society and the Korean Neuroendocrine Study Group have developed a position statement for the use of somatostatin analogues in the medical treatment of acromegaly. This position statement is based on evidence from the current literature and expert opinions. In the case of discrepancies among expert opinions, the experts voted to determine the recommended approach.

Medical Treatment with Somatostatin Analogues in Acromegaly: Position Statement

The Korean Endocrine Society (KES) published clinical practice guidelines for the treatment of acromegaly in 2011. Since then, the number of acromegaly cases, publications on studies addressing medical treatment of acromegaly, and demands for improvements in insurance coverage have been dramatically increasing. In 2017, the KES Committee of Health Insurance decided to publish a position statement regarding the use of somatostatin analogues in acromegaly. Accordingly, consensus opinions for the position statement were collected after intensive review of the relevant literature and discussions among experts affiliated with the KES, and the Korean Neuroendocrine Study Group. This position statement includes the characteristics, indications, dose, interval (including extended dose interval in case of lanreotide autogel), switching and preoperative use of somatostatin analogues in medical treatment of acromegaly. The recommended approach is based on the expert opinions in case of insufficient clinical evidence, and where discrepancies among the expert opinions were found, the experts voted to determine the recommended approach.

Congenital hyperinsulinism in two siblings with ABCC8 mutation: same genotype, different phenotypes

SUMMARY Congenital hyperinsulinism (CHI) is a heterogenous disease caused by insulin secretion regulatory defects, being ABCC8/KCNJ11 the most commonly affected genes. Therapeutic options include diazoxide, somatostatin analogues and surgery, which is curative in focal CHI. We report the case of two siblings (born two years apart) that presented themselves with hypoketotic hyperinsulinemic persistent hypoglycemias during neonatal period. The diagnosis of diffuse CHI due to an ABCC8 compound mutation (c.3576delG and c.742C>T) was concluded. They did not benefit from diazoxide therapy (or pancreatectomy performed in patient number 1) yet responded to somatostatin analogues. Patient number 1 developed various neurological deficits (including epilepsy), however patient number 2 experienced an entirely normal neurodevelopment. We believe this case shows how previous knowledge of the firstborn sibling's disease contributed to a better and timelier medical care in patient number 2, which could potentially explain her better neurological outcome despite their same genotype.

Tumor neuroendocrino ileal con síndrome carcinoide de difícil control / Neuroendocrine ileal tumor with difficult to control carcinoid syndrome

Resumen Los tumores neuroendocrinos son neoplasias infrecuentes y de abordaje complejo. Actualmente se necesitan más ensayos clínicos aleatorizados para establecer el manejo óptimo de los pacientes afectados por metástasis hepáticas no resecables. Aportamos un caso de TNE metastásico en el que se indicó trasplante hepático por sintomatología derivada del síndrome carcinoide no controlable con el tratamiento médico habitual. (Acta Med Colomb 2018; 43: 161-164).

Abstract Neuroendocrine tumors are infrequent neoplasms with a complex approach. Currently, more randomized clinical trials are needed to establish the optimal management of patients affected by unresectable liver metastases. A case of metastatic NET in which hepatic transplantation was indicated due to symptoms derived from the carcinoid syndrome that cannot be controlled with the usual medical treatment is provided.

Acetato de lanreotida para o tratamento de tumores neuroendócrinos gastroenteropancreáticos / Lanreotide acetate for the treatment of gastroenteropancreatic neuroendocrine tumors

CONTEXTO: Os tumores neuroendócrinos gastrintestinais e do pâncreas constituem um grupo heterogêneo de tumores com origem no sistema neuroendócrino difuso do trato gastrintestinal e de células neuroendócrinas ou pluripotentes do pâncreas. A maioria ocorre no jejuno, íleo, cólon e reto. As prevalências variam de 20 a 35 por 100.000, enquanto as incidências entre 2,5 a 5,25 por 100.000 pessoas/ano. A histopatologia tumoral, o tamanho e a extensão, comprometimento locorregional e presença de metástases hepáticas são fundamentais para o diagnóstico, prognóstico e para o planejamento da conduta terapêutica. Essas características influenciam na sobrevida global. Dessa forma, os tumores podem ser classificados em diferenciados de grau 1 (G1) e grau 2 (G2) ou pouco diferenciados de grau 3 (G3) e ainda nos estádios I a IV de acordo com comprometimento locorregional e presença de metástase. Os tumores mais diferenciados, em estádios menores e sem metástases hepáticas tem melhor prognóstico com maior sobrevida global. Esses tumores em função de suas características geralmente não são diagnosticados até que a doença envolva outros órgãos (dor e obstrução) ou na presença de metástases hepáticas, com prejuízo ao funcionamento desse órgão. A mediana da sobrevida global em indivíduos com tumores bem ou moderadamente diferenciados e com metástases distantes é de 33 meses. TECNOLOGIA: Acetato de Lanreotida. INDICAÇÃO: Tratamento de tumores neuroendócrinos gastroenteropancreáticos irressecáveis metastáticos. PERGUNTA: "Análogos de somatostatina são eficazes e seguros no tratamento de adultos diagnosticados com tumores neuroendócrinos gastroenteropancreáticos irressecáveis localmente avançados ou metastáticos ou ativos após a cirurgia?" EVIDÊNCIAS CIENTÍFICAS: Foi construída estratégia e conduzida busca estruturada. Recuperaramse 7 estudos clínicos e outros estudos de extensão e de análise de subgrupos. Os participantes tinham tumores neuroendócrinos irressecáveis localmente avançados ou metastáticos de graus 1 ou 2, com as lesões primárias localizadas principalmente no intestino médio e pâncreas e com metástases majoritariamente hepáticas. Em dois estudos com melhor qualidade metodológica compararam-se os análogos de somatostatina (AS) lanreotida e octreotida com placebo em participantes não tratados anteriormente. Não há estudos de comparação direta entre esses dois medicamentos. Pode-se observar um efeito de ambos os AS na sobrevida livre de progressão, de forma que a chance de progressão tumoral ou morte foi 68% menor, a qualquer tempo, no grupo que recebeu octreotida LAR em relação ao grupo que recebeu placebo (HR 0,32; IC 95% 0,19 a 0,55; P=0,000015) e 53% menor no grupo que recebeu lanreotida em comparação com placebo (HR 0,47; IC 95% 0,30 a 0,73). Em indivíduos com progressão da doença em uso de análogos de somatostatina há evidência de qualidade metodológica mais limitada de que a associação de octreotida e everolimo traga maior benefício na sobrevida livre de progressão que o uso de octreotida isolado. Não foram relatados casos de regressão tumoral e poucos com resposta parcial sendo o principal efeito dos medicamentos o de estabilização dos tumores avaliado por critérios radiológicos. Pela análise de evidência de baixa qualidade metodológica não se observa efeito desses medicamentos na sobrevida global dos participantes. AVALIAÇÃO ECONÔMICA: Foi elaborado estudo de custo-efetividade para comparar o uso de lanreotida de liberação prologada com a conduta expectante em modelo de Markov. Os desfechos avaliados foram sobrevida global e anos de vida ajustados pela qualidade em 6 e 30 anos. As razões incrementais de custo-efetividade foram de R$ 52.775,13 e R$ 40.478,00 por ano de vida ganho nos horizontes temporais de 6 e 30 anos, respectivamente. AVALIAÇÃO DE IMPACTO ORÇAMENTÁRIO: O demandante conduziu uma análise de impacto orçamentário na perspectiva do SUS projetando os gastos de uma possível incorporação de lanreotida de liberação prolongada (120 mg) para tratamento de tumores neuroendócrinos gastroenteropancreáticos no período de cinco anos em comparação com a conduta expectante. Utilizando-se o pressuposto de 100% de utilização do medicamento pelo sistema de saúde obteve-se como resultado impactos orçamentários incrementais de R$ 103,63 milhões no primeiro ano e de R$ 674,00 milhões como acumulado para os cinco anos. Aplicando-se taxas de difusão e pressupondo uma utilização gradual do medicamento obtêm-se impactos orçamentários incrementais de R$ 18,6 milhões para o primeiro ano e de R$ 252,00 milhões para os cinco anos. RECOMENDAÇÃO INICIAL DA CONITEC: Os membros do plenário da CONITEC decidiram na 62ª reunião ordinária da Comissão em 6 de dezembro de 2017, por unanimidade, não criar um novo procedimento específico para tratamento de tumores neuroendócrinos com lanreotida, entendendo que já existe procedimento no SUS para tratamento desses tumores. CONSULTA PÚBLICA: A consulta pública nº 02/2018 foi realizada entre os dias 18/01/2018 e 06/02/2018. Foram recebidas 75 contribuições, sendo 22 pelo formulário para contribuições técnico-científicas e 53 pelo formulário para contribuições sobre experiência ou opinião de pacientes, familiares, amigos ou cuidadores de pacientes, profissionais de saúde ou pessoas interessadas no tema. Após apreciação das contribuições encaminhadas pela consulta pública, o plenário da CONITEC entendeu que não houve argumentação suficiente para alterar a sua recomendação inicial pela não incorporação do medicamento. Propôs-se como possibilidade a revisão do procedimento (quimioterapia paliativa de apudoma/tumor neuroendócrino) para que se avalie a real necessidade de alteração do valor e das especificações frente aos novos tratamentos aprovados para os tumores neuroendócrinos irressecáveis. RECOMENDAÇÃO FINAL DA CONITEC: Os membros da CONITEC presentes na 64ª reunião ordinária, no dia 07 de março de 2018, deliberaram por unanimidade recomendar a não criação de procedimento quimioterápico específico para o uso da lanreotida para tratamento de tumores neuroendócrinos gastroenteropancreáticos. Foi assinado o Registro de Deliberação nº 336/2018 pela não incorporação da tecnologia. DECISÃO FINAL: O Secretário de Ciência, Tecnologia e Insumos Estratégicos do Ministério da Saúde, por meio da Portaria SCTIE/MS nº 16, de 27 de abril de 2018, publicada no DOU nº 82 de 30 de abril de 2018, Seção I, tornou pública a decisão de não criar procedimento quimioterápico específico para o uso do Acetato de Lanreotida para tratamento de tumores neuroendócrinos gastroenteropancreáticos.(AU)