Non-cirrhotic hyperammonaemic encephalopathy secondary to metastatic pancreatic neuroendocrine tumour treated with peptide receptor radio nucleotide therapy and transarterial chemoembolisation
- Author(s)
- Holmes, Z; Beasley, H; Naidoo, M; Michael, M;
- 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
- Publisher's Version
- https://doi.org/10.1136/bcr-2023-258516
- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2024-02-13 06:41:38
Last Modified: 2024-02-13 06:51:51