1. < Neuroendocrine Tumors (NETs)
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Use of Adrenaline/Epinephrine

Posted by Teresa, Volunteer Mentor @hopeful33250, Jun 7, 2017

Hello @amyh2439 @tresjur @joannem @gaylejean @lucci50 @derekd @gulzar @joanney @jenchaney727@dzerfas @lorettanebraska @wordnoid @trouble and @upblueeyes @ahtaylor @heidilynn4 @junebug15 @tomewilson

There has been some discussion among our members regarding the use of Adrenaline/Epinephrine in NET patients. As there have been some doctors who have offered different opinions, I obtained an opinion from Dr. Halfdanarson (one of the Neuroendocrine tumor oncologists at Mayo, Rochester, MN). Here is what he had to say:

As for the adrenaline/epinephrine, an injection of EPI can release massive amounts of serotonin. I would never withhold EPI in a NET patient who truly needs it (someone in extremis from anaphylaxis) but use it with great caution in all other patients. For example, I suggest not using it in the local anesthetic used for dental procedures if at all possible. I think the risk of exacerbating carcinoid crisis is vastly overstated but it is better to be safe than sorry.

Interested in more discussions like this? Go to the Neuroendocrine Tumors (NETs) Support Group.

gaylejean | @gaylejean | Jun 7, 2017

Exactly what my Mayo Clinic oncologist said.

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debf | @debf | Aug 5, 2017

Hello. My 16 year old son was diagnosed with metastatic PNETs last November at Mayo in MN, but is currently being treated at Ohio State because that is where we live. He is on monthly Lanreotide shots and has been feeling really well. He has non-functional tumors and does not appear to have carcinoid syndrome. He is having his wisdom teeth removed next week and I wondered if anyone knew if he has to avoid epinephrine in the anesthesia even if he doesn't have carcinoid syndrome?

Thank you!
Deb

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1 reply
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Teresa, Volunteer Mentor | @hopeful33250 | Aug 5, 2017

Hello Deb, @debf

Interesting question that you posed. I assume that you know for sure that epinephrine is in the anesthesia? I'm going to leave this question to other members and see what they have to say.

In the meantime, though, what do you mean by a non-functional NET tumor?

Also, could you share a little of your son's story with us? For example, what symptoms led to this diagnosis? Has he had surgery?

Teresa

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1 reply
debf | @debf | Aug 5, 2017

It's my understanding that non-functional tumors are ones that don't secrete hormones like insulin or glucagon and are not associated with a hormonal syndrome like carcinoid syndrome.

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1 reply
debf | @debf | Aug 5, 2017
In reply to @hopeful33250 "Hello Deb, @debf Interesting question that you posed. I assume that you know for sure that..." + (show)
@hopeful33250

Hello Deb, @debf

Interesting question that you posed. I assume that you know for sure that epinephrine is in the anesthesia? I'm going to leave this question to other members and see what they have to say.

In the meantime, though, what do you mean by a non-functional NET tumor?

Also, could you share a little of your son's story with us? For example, what symptoms led to this diagnosis? Has he had surgery?

Teresa

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He had stomach pain and diarrhea for 4 years (since 5th grade) and even after numerous tests, they were not able to figure out what was wrong. Then last June of 2016 he became Jaundice and they saw a mass in the head of his pancreas. They misdiagnosed it again as Autoimmune Pancreatitis and he was put on steroids. That didn't work so in November of 2016 he went to Mayo for a Whipple with Dr. Kendrick. During surgery they found the cancer and diagnosed it as pancreatic neuroendocrine cancer, unfortunately with metastasis to the liver. He is doing much better after surgery and no longer has pain, just occasional diarrhea. He is currently living life as a normal 16 year old, which we are extremely thankful for! Take enzymes when he eats, and is on the monthly Lanreotide shot.

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Mentor
Teresa, Volunteer Mentor | @hopeful33250 | Aug 5, 2017
In reply to @debf "It's my understanding that non-functional tumors are ones that don't secrete hormones like insulin or glucagon..." + (show)
@debf

It's my understanding that non-functional tumors are ones that don't secrete hormones like insulin or glucagon and are not associated with a hormonal syndrome like carcinoid syndrome.

Jump to this post

@debf

I appreciate the information and I'm so glad that your son is living the life of a normal 16 year old! How wonderful

Teresa

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Mentor
Teresa, Volunteer Mentor | @hopeful33250 | Aug 8, 2017
In reply to @debf "Hello. My 16 year old son was diagnosed with metastatic PNETs last November at Mayo in..." + (show)
@debf

Hello. My 16 year old son was diagnosed with metastatic PNETs last November at Mayo in MN, but is currently being treated at Ohio State because that is where we live. He is on monthly Lanreotide shots and has been feeling really well. He has non-functional tumors and does not appear to have carcinoid syndrome. He is having his wisdom teeth removed next week and I wondered if anyone knew if he has to avoid epinephrine in the anesthesia even if he doesn't have carcinoid syndrome?

Thank you!
Deb

Jump to this post

Hello Deb @debf

I have been thinking about you and your son. Did you contact his doctor to see about the dental procedure and the epinephrine in the anesthesia? If you feel comfortable doing so, please let us know how the procedure goes for him.

Teresa

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