Intestinal proliferation and delayed intestinal transit in a patient with a GLP-1-, GLP-2- and PYY-producing neuroendocrine carcinoma

被引:35
作者
Byrne, MM
McGregor, GP
Barth, P
Rothmund, M
Göke, B
Arnold, R
机构
[1] Univ Marburg, Dept Gastroenterol & Endocrinol, D-35033 Marburg, Germany
[2] Univ Marburg, Inst Physiol, D-35033 Marburg, Germany
[3] Univ Marburg, Dept Pathol, D-35033 Marburg, Germany
[4] Univ Marburg, Dept Gen Surg, D-35033 Marburg, Germany
[5] Univ Bern, Inselspital, Dept Gastroenterol, CH-3012 Bern, Switzerland
关键词
glucagon-like peptide-1; glucagon-like peptide-2; polypeptide YY; enteroglucagonoma; intestinal hypertrophy; intestinal motility;
D O I
10.1159/000051874
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Glucagon-like peptides (GLP) 1 and 2 are hormones derived from the post-translational processing of proglucagon in the intestinal L cells that influence intestinal motility and small bowel growth, respectively. We describe a patient with a neuroendocrine tumor of unknown primary origin with peritoneal carcinomatosis and diffuse liver metastases, who presented with constipation and nocturnal itching for over 3 yea rs. Small bowel follow-through showed decreased small intestinal motility and marked intestinal hypertrophy. Biopsies from mesenterial lymph nodes showed, histologically, a well-differentiated neuroendocrine tumor (G1), with positive immunostaining for chromogranin A, GLP-1, GLP-2 and polypeptide YY (PYY). Jejunal biopsy demonstrated marked intestinal mucosal hypertrophy. HPLC analysis combined with RIA of tumor and serum extracts revealed that the tumor was producing and releasing fasting levels of GLP-1 of 738+/-20.7 pg/ml (normal levels (nl) <100 pg/ml), GLP-2 of 3,150+/-9 pg/ml (nl <100 pg/ml) as well as PYY 550 pg/ml (nl <100 pg/ml). Octreotide administration decreased levels of GLP-1 and GLP-2 and reduced small intestinal transit time from 150 to 50 min. However, tumor growth was not inhibited by octreotide, interferon or dacarbazine therapy and the patient died 8 months later. This is the first case report demonstrating the overproduction of GLP-1, GLP-2 and PYY from an neuroendocrine tumor, in a patient with intestinal hypertrophy and delayed intestinal transit time. Copyright (C) 2001 S. Karger AG, Basel.
引用
收藏
页码:61 / 68
页数:8
相关论文
共 28 条
[1]   ENTEROGLUCAGON TUMOR [J].
BLOOM, SR .
GUT, 1972, 13 (07) :520-&
[2]   Circulating and tissue forms of the intestinal growth factor, glucagon-like peptide-2 [J].
Brubaker, PL ;
Crivici, A ;
Izzo, N ;
Ehrlich, P ;
Tsai, CH ;
Drucker, DJ .
ENDOCRINOLOGY, 1997, 138 (11) :4837-4843
[3]   Prevention of parenteral nutrition-induced gut hypoplasia by coinfusion of glucagon-like peptide-2 [J].
Chance, WT ;
FoleyNelson, T ;
Thomas, I ;
Balasubramaniam, A .
AMERICAN JOURNAL OF PHYSIOLOGY-GASTROINTESTINAL AND LIVER PHYSIOLOGY, 1997, 273 (02) :G559-G563
[4]   Induction of intestinal epithelial proliferation by glucagon-like peptide 2 [J].
Drucker, DJ ;
Ehrlich, P ;
Asa, SL ;
Brubaker, PL .
PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA, 1996, 93 (15) :7911-7916
[5]   ILEAL PROGLUCAGON GENE-EXPRESSION IN THE RAT - CHARACTERIZATION IN INTESTINAL ADAPTATION USING INSITU HYBRIDIZATION [J].
FULLER, PJ ;
BEVERIDGE, DJ ;
TAYLOR, RG .
GASTROENTEROLOGY, 1993, 104 (02) :459-466
[6]   MOLECULAR-FORMS OF GLUCAGON-LIKE PEPTIDES IN MAN [J].
GEORGE, SK ;
UTTENTHAL, LO ;
GHIGLIONE, M ;
BLOOM, SR .
FEBS LETTERS, 1985, 192 (02) :275-278
[7]   MEASUREMENT OF GASTRIC-EMPTYING RATE OF SOLIDS BY MEANS OF A CARBON-LABELED OCTANOIC-ACID BREATH TEST [J].
GHOOS, YF ;
MAES, BD ;
GEYPENS, BJ ;
MYS, G ;
HIELE, MI ;
RUTGEERTS, PJ ;
VANTRAPPEN, G .
GASTROENTEROLOGY, 1993, 104 (06) :1640-1647
[8]   ENDOCRINE TUMOUR IN KIDNEY AFFECTING SMALL BOWEL STRUCTURE, MOTILITY, AND ABSORPTIVE FUNCTION [J].
GLEESON, MH ;
BLOOM, SR ;
POLAK, JM ;
HENRY, K ;
DOWLING, RH .
GUT, 1971, 12 (10) :773-+
[9]   2 MOLECULAR-FORMS OF PEPTIDE YY (PYY) ARE ABUNDANT IN HUMAN BLOOD - CHARACTERIZATION OF A RADIOIMMUNOASSAY RECOGNIZING PYY-1-36 AND PYY-3-36 [J].
GRANDT, D ;
SCHIMICZEK, M ;
BEGLINGER, C ;
LAYER, P ;
GOEBELL, H ;
EYSSELEIN, VE ;
REEVE, JR .
REGULATORY PEPTIDES, 1994, 51 (02) :151-159
[10]   TRUNCATED GLUCAGONLIKE PEPTIDE-I, AN INSULIN-RELEASING HORMONE FROM THE DISTAL GUT [J].
HOLST, JJ ;
ORSKOV, C ;
NIELSEN, OV ;
SCHWARTZ, TW .
FEBS LETTERS, 1987, 211 (02) :169-174