Dr. Anthony Heaney
Associate Professor, Medicine and Neurosurgery
More Diagnosis POVs
- Dr. Metz [gastroenterologist] Understanding the variable presentation of NETs.
- Dr. Howden [gastroenterologist] Diagnosing the causes of diarrhea.
- Dr. Howden [gastroenterologist] Managing expectations of patients referred to multidisciplinary referral centers with an irritable bowel syndrome (IBS) diagnosis.
- Dr. Howden [gastroenterologist] The gastroenterologist may be involved with diagnosis, patient management, or both.
- Dr. Metz [gastroenterologist] Tools for making the diagnosis.
- Dr. Klimstra [surgical pathologist] A careful pathologic assessment is required.
Patients' symptoms are often attributed to other causes.
In my experience, the number of patients who have been diagnosed with other conditions prior to being diagnosed with neuroendocrine tumor is quite significant. The most typical scenario that I think all of us see is the patient who is now presenting with obvious metastatic serotonin-producing, mid-gut carcinoid tumor, who, for many years has been advised that they have had an irritable bowel syndrome. I think that is a very common scenario, very challenging area of these neuroendocrine tumors.
Another area that I would see that has been diagnosed with other conditions are early functioning pancreatic neuroendocrine tumors, which are causing vague symptoms of fatigue and association typically with mild catecholaminergic symptoms. These are patients who maybe have, palpitation, heart racing, perspiration, etc. It is being attributed to all sorts of things, including menopause, anxiety, psychosomatic-type conditions, and really, these have been the very early symptoms of a functioning pancreatic neuroendocrine tumor, either producing insulin-causing early mild hypoglycemia, or perhaps, some other tachykinin-like peptide, [which] has been causing vasomotor type symptoms. It is not uncommon to see patients with these tumors who have been misdiagnosed or miscategorized as having either no condition or some other medical condition.