VIPoma medical therapy: Difference between revisions
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*[[Sandostatin|Somatostatin]] analogues like short acting octreotide (50-100mcg every 8 hours) are useful for controlling diarrhea by blocking the release of VIP. Octreotide is later replaced by longer acting depot preparation of somatostatin analogues like sandostatin (20 mg IM every 4 weeks) and Lanreotide (120mg subQ every 4 weeks) | *[[Sandostatin|Somatostatin]] analogues like short acting octreotide (50-100mcg every 8 hours) are useful for controlling diarrhea by blocking the release of VIP. Octreotide is later replaced by longer acting depot preparation of somatostatin analogues like sandostatin (20 mg IM every 4 weeks) and Lanreotide (120mg subQ every 4 weeks) | ||
*[[Steroids]] are used in diarrhea of VIPoma refractory to somatostatin (prednisone 60 mg per day). | *[[Steroids]] are used in diarrhea of VIPoma refractory to somatostatin (prednisone 60 mg per day). | ||
*Sunitinib a tyrosin kinase inhibitor has some evidence of symptomatic and biochemical control in somatostatin analogue resistant VIPoma.<ref name="pmid27461388">{{cite journal| author=Dimitriadis GK, Weickert MO, Randeva HS, Kaltsas G, Grossman A| title=Medical management of secretory syndromes related to gastroenteropancreatic neuroendocrine tumours. | journal=Endocr Relat Cancer | year= 2016 | volume= 23 | issue= 9 | pages= R423-36 | pmid=27461388 | doi=10.1530/ERC-16-0200 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27461388 }}</ref> | *Sunitinib a tyrosin kinase inhibitor has some evidence of symptomatic and biochemical control in somatostatin analogue resistant VIPoma.<ref name="pmid27461388">{{cite journal| author=Dimitriadis GK, Weickert MO, Randeva HS, Kaltsas G, Grossman A| title=Medical management of secretory syndromes related to gastroenteropancreatic neuroendocrine tumours. | journal=Endocr Relat Cancer | year= 2016 | volume= 23 | issue= 9 | pages= R423-36 | pmid=27461388 | doi=10.1530/ERC-16-0200 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27461388 }}</ref> It is also a medical treatment for locally advanced unresectable or advanced metastatic VIPoma. | ||
*Prostaglandin synthesis inhibitors (e.g., [[indomethacin]]), [[phenothiazines]], and [[lithium]] combination may be used. | *Prostaglandin synthesis inhibitors (e.g., [[indomethacin]]), [[phenothiazines]], and [[lithium]] combination may be used. | ||
*Long-term [[octreotide]] treatment not only controls the [[diarrhea]] in the patients with VIPoma but also may cause arrest or regression of the tumor. | *Long-term [[octreotide]] treatment not only controls the [[diarrhea]] in the patients with VIPoma but also may cause arrest or regression of the tumor. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Madhu Sigdel M.B.B.S.[2]Parminder Dhingra, M.D. [3]
Overview
Initial treatment in patient with VIPoma is prompt replacement of fluid and correction of electrolyte imbalance and acid-base disturbance.[1]
Medical Therapy
Symptomatic treatment:
- Initial treatment in patient with VIPoma is prompt replacement of fluid and electrolyte losses. The IV fluid of choice is isotonic normal saline with added potassium and bicarbonate as necessary.
- Somatostatin analogues like short acting octreotide (50-100mcg every 8 hours) are useful for controlling diarrhea by blocking the release of VIP. Octreotide is later replaced by longer acting depot preparation of somatostatin analogues like sandostatin (20 mg IM every 4 weeks) and Lanreotide (120mg subQ every 4 weeks)
- Steroids are used in diarrhea of VIPoma refractory to somatostatin (prednisone 60 mg per day).
- Sunitinib a tyrosin kinase inhibitor has some evidence of symptomatic and biochemical control in somatostatin analogue resistant VIPoma.[2] It is also a medical treatment for locally advanced unresectable or advanced metastatic VIPoma.
- Prostaglandin synthesis inhibitors (e.g., indomethacin), phenothiazines, and lithium combination may be used.
- Long-term octreotide treatment not only controls the diarrhea in the patients with VIPoma but also may cause arrest or regression of the tumor.
References
- ↑ Vinik A. Vasoactive Intestinal Peptide Tumor (VIPoma) [Updated 2013 Nov 28]. In: De Groot LJ, Beck-Peccoz P, Chrousos G, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: http://www.ncbi.nlm.nih.gov/books/NBK278960/
- ↑ Dimitriadis GK, Weickert MO, Randeva HS, Kaltsas G, Grossman A (2016). "Medical management of secretory syndromes related to gastroenteropancreatic neuroendocrine tumours". Endocr Relat Cancer. 23 (9): R423–36. doi:10.1530/ERC-16-0200. PMID 27461388.