Hyperammonemic Encephalopathy in a Patient with Pancreatic Neuroendocrine Tumor and Portosystemic Shunt
Abstract
1. Introduction
2. Case Report
3. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Cause | Mechanism or Examples |
---|---|
Extensive liver disease due to cirrhosis or metastases | Impaired urea cycle due to damaged hepatocytes and portosystemic shunting |
Kidney failure | Excess of ammonia cannot be excreted as urea |
Small intestinal bacterial overgrowth | Increased production of ammonia |
Urease producing infection/sepsis | Increased production of ammonia, e.g., Proteus, H.Pylori, Nocardia, Klebsiella, Cryptococcus, Mycoplasma |
Drugs | Valproic acid, carbamazepine, salicylate intoxication, f-fluorouracil, L-asparaginase |
Reye syndrome | Impaired urea cycle, mitochondrial dysfunction |
Reference | Differentiation | Grade NEN |
---|---|---|
Naringrekar et al., 2017 [16] | Unknown | Grade 2 (KI-67: 5%) |
Singh et al., 2008 [8] | Well | Unknown |
Santes et al., 2017 [17] | Well | Grade 1 (Ki-67: <1%) |
Bhargava et al., 2018 [18] | Well | Grade 1 (Ki-67: <2%) |
Salahshour et al., 2021 [19] | Well | Grade 1 (Ki-67: <1%) |
Yazawa et al., 2011 [20] | Well | Grade 3 (Ki-67: 30–40%) |
Reference | Pancreatic Involvement NET | Hepatic Involvement NET | Hepatic Vascular Pathology |
---|---|---|---|
Monardo et al., 2020 [3] | Yes | No | Possible portosystemic shunt. |
Broadbridge et al., 2010 [4] | Yes | Yes | Portosystemic shunt due to portal vein thrombosis. |
Clinicopathologic conference. 1991 [5] | Yes | Yes | Portosystemic shunt due to tumoral portal vein thrombosis. |
Erinjeri et al., 2010 [6] | Yes | Yes | Portosystemic shunt due to arterioportal shunt. |
Turken et al., 2009 [7] | No | Yes | No. |
Singh et al., 2008 [8] | Yes | No | Atypical hemangioma. Signs of portal hypertension (splenomegaly, engorgement of portal vein and esophageal varices) but no cirrhosis. |
Pande et al., 2016 [9] | No | Yes | No. |
Vandamme et al., 2012 [10] | Yes | Yes | Mechanical compression of tumor on portal vein. |
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Zorgdrager, M.; Cuperus, F.J.C.; de Haas, R.J. Hyperammonemic Encephalopathy in a Patient with Pancreatic Neuroendocrine Tumor and Portosystemic Shunt. Diagnostics 2023, 13, 572. https://doi.org/10.3390/diagnostics13030572
Zorgdrager M, Cuperus FJC, de Haas RJ. Hyperammonemic Encephalopathy in a Patient with Pancreatic Neuroendocrine Tumor and Portosystemic Shunt. Diagnostics. 2023; 13(3):572. https://doi.org/10.3390/diagnostics13030572
Chicago/Turabian StyleZorgdrager, Marcel, Frans J. C. Cuperus, and Robbert J. de Haas. 2023. "Hyperammonemic Encephalopathy in a Patient with Pancreatic Neuroendocrine Tumor and Portosystemic Shunt" Diagnostics 13, no. 3: 572. https://doi.org/10.3390/diagnostics13030572
APA StyleZorgdrager, M., Cuperus, F. J. C., & de Haas, R. J. (2023). Hyperammonemic Encephalopathy in a Patient with Pancreatic Neuroendocrine Tumor and Portosystemic Shunt. Diagnostics, 13(3), 572. https://doi.org/10.3390/diagnostics13030572