Reversing Hyperammonemia in Neuroendocrine Tumors.
Ammonia is a neurotoxin that is normally cleared by the intact liver and if not, hyperammonemia results in hepatic encephalopathy. Hyperammonemia may be owing to primary or secondary causes. Early diagnosis is important to prevent permanent brain damage. Advanced malignancy involving the liver is associated with hyperammonemia as a result of abnormality of the portal venous system or massive hepatic tumor burdon. Neuroendocrine tumors are an example of a malignant process that frequently involves the liver but despite this, may still have a relatively good prognosis, and are often characterized by chronic manageable symptoms and slow progression. Hyperammonemia in neuroendocrine tumor would represent a potentially reversible but ongoing process associated with an indolent malignancy. We present 2 cases that are examples of this diagnosis and discuss the diagnostic and management issues that may arise.
Broadbridge
Vy
V
Department of Medical Oncology, The Queen Elizabeth Hopsital, Woodville, SA.
Townsend
Amanda
A
Pittman
Kenneth
K
Kimber
Richard
R
Patterson
William
W
Sukumaran
Shawgi
S
Price
Timothy J
TJ
D000368:Aged; D003131:Combined Modality Therapy; D017809:Fatal Outcome; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006501:Hepatic Encephalopathy / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D022124:Hyperammonemia / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D007792:Lactulose / Q000627:therapeutic use*; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000150:complications* / Q000175:diagnosis; D010166:Palliative Care; D006435:Renal Dialysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D005765:Gastrointestinal Agents; D007792:Lactulose