Non-cirrhotic hyperammonaemic encephalopathy secondary to metastatic pancreatic neuroendocrine tumour treated with peptide receptor radio nucleotide therapy and transarterial chemoembolisation
Details
Publication Year 2024-01-03,Volume 17,Issue #1,Page e258516
Journal Title
BMJ Case Reports
Publication Type
Case report
Abstract
Neuroendocrine tumours (NETs) are rare cancers which often carry significant morbidity and mortality, frequently related to burden of liver metastases. Hyperammonaemia and subsequent hepatic encephalopathy carries a poor prognosis and has been described in these patients. We discuss a case of a woman in her 50s with hyperammonaemic encephalopathy and a new diagnosis of pancreatic NET with hepatic metastases. She presented with a reduced conscious state a few days post commencing chemotherapy. This was considered to have a multifactorial pathophysiology: the primary driver being large volume hepatic metastases and contributed by portosystemic microshunting, sepsis, severe weight loss and malnutrition. We describe how each of these exacerbating factors was addressed and highlight the effective multimodal treatment approach consisting of sequential transarterial chemoembolisation followed by peptide receptor radio nucleotide therapy, resulting in the resolution of hyperammonaemic encephalopathy and radiological partial metabolic response.
Publisher
BMJ
Keywords
Female; Humans; *Neuroendocrine Tumors/therapy/secondary; *Liver Neoplasms/therapy/secondary; *Chemoembolization, Therapeutic/methods; *Neoplasms, Second Primary/therapy; *Pancreatic Neoplasms/complications/therapy; *Brain Diseases/therapy; Cancer intervention; Interventional radiology; Oncology
Department(s)
Medical Oncology
Terms of Use/Rights Notice
Refer to copyright notice on published article.


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Last Modified: 2024-02-13 06:51:51

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