title: Sunitinib-induced hyperammonaemia in a patient with pancreatic neuroendocrine tumour.
abstract: OBJECTIVE
  Sunitinib can improve progression-free survival and overall survival in patients with advanced pancreatic neuroendocrine tumor (PNET). From clinical trial, most commonly reported adverse events of sunitinib were neutropenia (12%), diarrhea (10%), asthenia (7%), erythrodysesthesia (7%), hypertension (7%) and thrombocytopenia (6%).
  
  
  METHODS
  We report a patient with PNET with liver metastases who developed hyperammonemia with a low dosage of sunitinib probably contributed by the presence of liver metastases.
  
  
  CONCLUSIONS
  We would like to draw attention to the potential risk of sunitinib induced hyperammonemic encephalopathy even with a low dosage of sunitinib. The absence of sunitinib-induced hyperammonemia during its initial course does not rule out this possibility if there is increased in liver metastases. We suggest checking the ammonia level if patient on sunitinib presented with altered sensorium even if the liver function is normal.
authors.affiliation: Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China. elphashea@gmail.com
authors.forename: Y-f
authors.initials: YF
authors.lastname: Shea
authors.forename: W-y J
authors.initials: WY
authors.lastname: Chiu
authors.forename: M-y M
authors.initials: MY
authors.lastname: Mok
authors.forename: I F-n
authors.initials: IF
authors.lastname: Hung
authors.forename: C-c T
authors.initials: CC
authors.lastname: Yau
mesh_terms: D006801:Humans; D022124:Hyperammonemia / Q000139:chemically induced*; D007211:Indoles / Q000009:adverse effects* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000097:blood / Q000188:drug therapy*; D010190:Pancreatic Neoplasms / Q000097:blood / Q000188:drug therapy*; D011758:Pyrroles / Q000009:adverse effects* / Q000627:therapeutic use*; D000077210:Sunitinib
chemical_list: D007211:Indoles; D011758:Pyrroles; D000077210:Sunitinib
keywords: hyperammonaemia; neuroendocrine tumours; sunitinibs