Neuroendocrine complication

While a recent review concluded that there is evidence of neuroendocrine perturbations with VPA, it was also noted that well-controlled monotherapy studies are limited. Given the apparent increased incidence of polycystic ovarian syndrome (PCOS) associated with VPA therapy and uncertainty about the mechanism (e g., weight gain, interference with steroid metabolism), further study is warranted and clinicians should carefully monitor female patients on this agent for increased testosterone levels. Other strategies to minimize the risk of this complication include the following ... 

Elucidation of proteases in brain and neuroendocrine tissues is complicated because of the many different cell types and the presence of proteases in many subcellular compartments of these cells. To ensure that authentic proteases are identified for producing an active peptide, the neuropeptide field has used key criteria for successful elucidation of proteases that generate peptide neurotransmitters and hormones. These criteria... 

This type of complication may represent a permanent risk to the procedure because of the dependency on underlying disease. Changes in blood pressure, sensations of pain, and hormonal reactions (e.g. in RFA of the adrenals or in metastases of neuroendocrine tumours) can affect the patient s condition during the procedure. Therefore, it is mandatory to know the patient s medical condition before the procedure to be able to address any necessary additional medical support ahead of a potential complication. 

Gates J, Hartnell GG, Stuart KE, Clouse ME (1999) Chemoembolization of hepatic neoplasms safety, complications, and when to worry. Radiographics 19 399-414 Gattoni F, Dova S, Uslenghi CM (2000) Three-year followup of 62 cirrhotic patients with hepatocellular carcinoma treated with chemoembolization. Minerva Chir 55 31-37 Gupta S, Johnson MM, Murthy R et al (2005) Hepatic arterial embolization and chemoembolization for the treatment of patients with metastatic neuroendocrine tumors. Cancer 104 1590-1602... 

Serious complications following embolization of metastatic neuroendocrine tumor are uncommon with careful patient selection, thorough pre-procedure preparation, and meticulous angiographic technique [72], Reported major complication rates and death rates after emholotherapy for neuroendocrine tumor hepatic metastases range from 1% to 10%, and 0% to 3%, respectively. 

Table 14.3. Complications of emholotherapy for neuroendocrine tumor liver metastases...

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