The neuroendocrine markers assay and the glycemia profile in patients with neuroendocrine tumors under octreotide therapy: a 2 years study / Determinarea markerilor neuroendocrini şi a profilului glicemic la pacienţii cu tumori neuroendocrine în tratament cu octreotid

Abstract

Abstract The neuroendocrine tumors (NETs) are more frequent during the last decades. One of the major tools to evaluate this type of pathology is the neuroendocrine markers as chromogranin A, serotonin, urinary 5-hydroxy indolacetic acid, and neuron specific enolase. They change related to the disease progression, regardless therapy. Some of the drugs that are used for NETs as somatostatin analogs (for example octreotide) might interfere with glucose metabolism. Objectives. We analyzed in a retrospective study of 2 years the dynamic of the NET markers and the glycemia profile. Material and Methods. All the patients had at least one assay per year. Results. 9 patients were included (5 women and 4 men), with a mean age of 57.33 years. They were treated before the study with octreotide for 18 +/- 14.69 months. The dose of octreotide varied from 20 to 50 mg, monthly. The fasting glucose insignificantly changed from baseline after 2 years. No new case of diabetes was registered. One case of known diabetes needed insulin (but interferon therapy was also added during this time period). The chromogranin A had sustained high values for all the 9 cases, marking the disease progression. The neuron specific enolase significantly increased, and the serum serotonin as well as the 5HIIA was much higher in 2 cases with aggressive carcinoid symptoms. Conclusion. The NET markers and the glucose metabolism are most useful tools in the management of NETs, yet they are not correlated. Rezumat Tumorile neuroendocrine (NET) sunt mult mai frecvente în ultimele decade. Unul din intrumentele majore de evaluare în această patologie este reprezentat de dozarea markerilor neuroendocrini precum cromogranina A, serotonina, acidul 5-hidroxi indolacetic urinar şi enolaza neuronal specifică. Aceştia se schimbă cu progresia tumorală, indiferent de terapie. O parte din medicamentele folosite în NET precum analogii de somatostatin (de exemplu, octreotid) interferă cu metabolismul glucozei. Obiectiv. Am analizat într-un studiu retrospectiv de-a lungul a 2 ani dinamica markerilor NET şi profilul glicemic. Material si metode.Toţi pacienţii au avut cel puţin o evaluare pe an. Rezultate. 9 pacienţi au fost incluşi (5 femei şi 4 bărbaţi), cu o vârstă medie de 57,33 de ani. Perioada de tratament anterior cu octreotid a fost de 18 +/- 14,69 de luni. Doza de octreotid a variat de la 20 la 50 mg lunar. Glicemia s-a modificat nesemnificativ de la bază după 2 ani. Nu s-a înregistrat nici un caz nou de diabet. O pacientă a necesitat insulină pentru diabetul preexistent (dar între timp s-a adaugat şi terapie cu interferon) Cromogranina A a avut valori mari sustinute pentru toate cele 9 cazuri, sugerând progresia bolii. Enolaza neuronal specifică a crescut semnificativ iar serotonina serică şi 5HIIA au crescut considerabil în 2 cazuri cu simptome severe de sindrom carcinoid. Concluzie. Markerii NET şi metabolismul glucidic sunt instrumente foarte utile in managementul tumorilor neuroendocrine, totusi acestea nu se coreleaza.