ABSTRACT
Neuroendocrine tumors (NETs) are rare. When present, they often produce serotonin and are called carcinoids. Serotonin-secreting NETs can present with or without carcinoid syndrome. Although the idea of serotonin-secreting NETs potentially altering glucose metabolism is not new, data around this issue has been scarce, with only a few limited studies and case reports. We present a case where a female patient's prediabetic hemoglobin A1C levels normalized after removing serotonin-secreting NET. Before removal, the patient had locally metastatic carcinoid and serotonin-related intractable diarrhea but did not exhibit any other sign of carcinoid syndrome, including flushing, which is considered a hallmark. Therefore, in suggestive clinical contexts, this case points to the possibility of impaired glucose tolerance being an early clinical sign of carcinoid that could aid in serotonin-secreting NET diagnosis before it manifests as overt carcinoid syndrome.
ABSTRACT
CONTEXT: Rib raising is an osteopathic manipulative treatment modality that can help patients with various respiratory conditions to improve their work of breathing. However, the tolerance of this technique in hospitalized patients has not been assessed in a systematic manner. We hypothesized that rib raising would be a well-tolerated treatment modality for hospitalized patients admitted for asthma, pneumonia, chronic obstructive pulmonary disease, and/or congestive heart failure. OBJECTIVE: To determine hospitalized patients' tolerance of rib raising through a prospective pilot study. METHODS: The study included patients at University Hospitals-Richmond Medical Center and University Hospitals-Bedford Medical Center who were admitted for asthma, pneumonia, chronic obstructive pulmonary disease, and/or congestive heart failure between November 1, 2016, and October 31, 2017. Each patient was treated with rib raising, which was performed in a standardized fashion. Immediately after treatment, patients were asked to rate their tolerance of the procedure on a scale of 0 to 10, where 0 represented no discomfort and 10 represented maximum discomfort. RESULTS: The study population consisted of 87 hospitalized, non-intensive care unit patients. The mean tolerance score for rib raising was 1.18, and the median score was 0. The score was between 0 and 3 in 80 patients (92.0%), between 4 and 6 in 6 patients (6.9%), and between 7 and 10 in 1 patient (1.1%). CONCLUSION: Rib raising was shown to be well tolerated by the majority of the patients in the study population.
