Australasian Consensus Statement on the Identification, Prevention, and Management of Hormonal Crises in Patients with Neuroendocrine Neoplasms Undergoing Peptide Receptor Radionuclide Therapy

Minmin Li; David L Chan; Gonzalo Tapia Rico; Gabrielle Cehic; Ben Lawrence; David Wyld; David A Pattison; Grace Kong; Rodney Hicks; Michael Michael; Andrew Ddembe Kiberu; Jennifer Lim; Roderick Clifton-Bligh; Venessa Tsang; Paul J Roach; John Leyden; Connie I Diakos; Timothy J Price; Nick Pavlakis

doi:10.1159/000526848

Australasian Consensus Statement on the Identification, Prevention, and Management of Hormonal Crises in Patients with Neuroendocrine Neoplasms Undergoing Peptide Receptor Radionuclide Therapy

Neuroendocrinology. 2023;113(3):281-288. doi: 10.1159/000526848. Epub 2022 Sep 1.

Authors

Minmin Li¹, David L Chan^{2

3}, Gonzalo Tapia Rico^{4

5}, Gabrielle Cehic⁶, Ben Lawrence⁷, David Wyld⁸, David A Pattison^{9

10}, Grace Kong¹¹, Rodney Hicks¹¹, Michael Michael¹², Andrew Ddembe Kiberu¹³, Jennifer Lim¹⁴, Roderick Clifton-Bligh^{3

15}, Venessa Tsang^{3

15}, Paul J Roach^{3

16}, John Leyden^{17

18}, Connie I Diakos^{2

3}, Timothy J Price^{4

5}, Nick Pavlakis^{2

3}

Affiliations

¹ Department of Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia, [email protected].
² Department of Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia.
³ Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
⁴ Department of Medical Oncology, Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
⁵ Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.
⁶ Department of Nuclear Medicine, Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
⁷ Discipline of Oncology, University of Auckland, Auckland, New Zealand.
⁸ Department of Medical Oncology, Royal Brisbane and Womens Hospital, Brisbane, Queensland, Australia.
⁹ Department of Nuclear Medicine & Specialised PET Services, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia.
¹⁰ School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
¹¹ Neuroendocrine Tumour Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
¹² Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
¹³ Department of Medical Oncology, Fiona Stanley Hospital, Perth, Washington, Australia.
¹⁴ Department of Medical Oncology, St George Hospital, Sydney, New South Wales, Australia.
¹⁵ Department of Endocrinology, Royal North Shore Hospital, Sydney, New South Wales, Australia.
¹⁶ Department of Nuclear Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia.
¹⁷ Department of Anaesthesia and Pain Management, Royal North Shore Hospital, Sydney, New South Wales, Australia.
¹⁸ NeuroEndocrine Cancer Australia, Blairgowrie, Victoria, Australia.

PMID: 36049462
DOI: 10.1159/000526848

Abstract

Hormonal crises are a rare but increasingly recognized phenomenon following peptide receptor radionuclide therapy (PRRT) in patients with neuroendocrine neoplasms (NENs). Due to the paucity of published studies, approaches to the identification, prevention, and management of risk factors are inconsistent between different institutions. This consensus statement aimed to provide guidance for NEN patients undergoing PRRT. Our statement has been created on the basis of clinical demand and concerns regarding the precipitation of hormonal crises. A formal literature review was conducted to identify available studies. A total of 19 Australian and New Zealand experts in the fields of medical oncology, nuclear medicine, anaesthetics, and endocrinology collaborated on this consensus statement. The main focus is on carcinoid crises. Other hormonal crises seen in patients with functional pancreatic NENs are addressed briefly. These recommendations are relevant to PRRT centres internationally and should be tailored to local experience and available resources.

Keywords: Carcinoid crises; Hormonal crises; Lutate; Neuroendocrine tumour; Peptide receptor radionuclide therapy.

Publication types

Review

MeSH terms

Australia
Humans
Neuroendocrine Tumors* / drug therapy
Pancreatic Neoplasms* / drug therapy
Radioisotopes / therapeutic use
Receptors, Peptide

Substances

Radioisotopes
Receptors, Peptide