ORAL PRESENTATIONS – RESIDENTS SESSION 1
NEUROENDOCRINE TUMORS: ENDOCRINE INSIGHTS IN A CASE OF CHRONIC DIARRHEA Warda Siddiqui, Stephan Francis, Jason Taylor; Leonard J Chabert Medical Center, Houma, LA.
Introduction: Neuroendocrine neoplasms have an estimated global incidence of 6 out of 100,000 and a prevalence of 35 out of 100,000. The clinical trajectory of patients with well-differentiated gastroenteropancreatic neuroendocrine tumors (NET) varies greatly, with some remaining asymptomatic for years while others experience symptoms due to tumor size or hormone overproduction. Case: A 45-year-old male with GERD and tobacco dependence presented with chronic diarrhea for over two years, alongside sudden nausea, vomiting, diaphoresis, and fatigue over the past two weeks. He was unable to tolerate oral intake, vomiting 8-10 times prior to admission, and reported intermittent, stabbing, non-radiating periumbilical pain lasting over a year. Admission labs were significant for leukocytosis with a left shift, creatinine 1.4 μmol/L (baseline 1 μmol/L), lactate 4 mmol/L, ESR and CRP within normal limits. He had no family history of colon cancer and denied weight loss or constitutional symptoms. He was evaluated by his primary care physician and a gastroenterologist, and a outpatient CT-abdomen was significant for a soft-tissue mass behind the second portion of the duodenum. He underwent an esophagogastroduodenoscopy (EGD) and colonoscopy, revealing mild gastritis and
diverticulosis, and was diagnosed with irritable bowel syndrome subtype-D, for which he was prescribed loperamide and bentyl without significant relief. The patient received intravenous fluids, ciproloxicin/metronidazole, and odanesteron, and had negative stool studies. The leukocytosis and acute renal failure resolved by the next day, and he was tolerating a diet. He was discharged with a gastroenterology (GI) referral but was readmitted multiple times that month for similar symptoms and lab results. During his third admission, a repeat CT abdomen showed an enlarging soft-tissue lesion, with elevated chromogranin and HIAA levels. He underwent another EGD with ultrasound and a biopsy of peri duodenal lymph nodes confirmed a well-differentiated NET. He is now under the care of surgical oncology with a planned whipple procedure. Discussion: Clinicians should expand their differential for patients with recurrent GI symptoms, as NET treatment options differ markedly from those for other common conditions. While most NETs grow slowly, some can be aggressive, and certain tumors may secrete peptide hormones or biogenic amines, leading to significant hormonal syndromes. Early diagnosis is essential to reduce morbidity and mortality.
MYSTERY OF MADNESS: UNRAVELING A RARE CAUSE OF COMMON PSYCHIATRIC SYMPTOMS Saisruthi Regalla, Raja Saravanan, Ethan Greenblatt; Baton Rouge General Hospital, Baton Rouge, LA.
Introduction: Anti-N-methyl D-aspartate receptor (Anti-NMDAR) encephalitis is a type of autoimmune encephalitis that occurs due to the presence of IgG antibodies against the NR1 subunit of NMDA receptors in the central nervous system. The exact etiology of antibody production is unknown; however, it is stated that in some patients, antibody production is triggered by associated
ovarian teratoma, or prior herpes simplex virus encephalitis. It is a rare disease, affecting one out of 1.5 million people per year. Young adult females between 25-35 years are most affected. Case: A 20-year-old female was admitted to the psychiatry unit for evaluation of acute onset of bizarre behavior and persecutory delusions,
6
Made with FlippingBook Digital Publishing Software