Table 2.

Characteristics of patients with a hormonal crisis after ¹⁷⁷Lu-octreotate treatment

Case	Age/Sex	Tumor	Years since diagnosis	Treatment before 177Lu-octreotate	Clinical symptoms before 177Lu-octreotate	Relevant laboratory findings before 177Lu-octreotate	Continuation of somatostatin analogues prior to 177Lu-octreotate	Onset of “crisis” in relation to administration of 177Lu-octreotate	Predominant symptomatology	Treatment of “crisis”	Duration of hospitalization	Disease course
1	65/M	Bronchial carcinoid with mediastinal lymph node, liver and bone metastases	4	External radiation therapy, octreotide LAR	Flushing and diarrhea, several carcinoid crises requiring hospitalization	CgA 4,379 μg/l, urinary 5HIAA 399 μmol/24 h	No	Immediately	Nausea, worsening of diarrhea, severe flushing	Fluids i.v., octreotide, corticosteroids, metoclopramide, loperamide	5 days	2 more cycles of 177Lu-octreotate treatment without discontinuation of octreotide treatment. Both again leading to hormonal release requiring hospitalization. Died after 1 year because of progressive disease
2	62/F	Bronchial carcinoid with liver and bone metastases	11	Lobectomy left upper lobe, external radiation therapy, intrabronchial laser coagulation of tumor, octreotide LAR, interferon-alpha	Flushing and diarrhea, carcinoid crisis after intrabronchial laser coagulation of tumor	CgA 110,000 μg/l 978 μmol/24 h	No	After 2 days	Severe flushing, worsening of diarrhea, dehydration	Fluids i.v., corticosteroids, octreotide	11 days	3 more cycles of 177Lu-octreotate, with discontinuation of octreotide treatment without serious side effects. Died after 1 year because of progressive disease
3	53/F	VIPoma with liver metastases	1	Distal pancreatectomy, radiofrequency ablation of liver metastases, cisplatin, etoposide, octreotide LAR	Severe diarrhea, hypokalemia and dehydration	VIP 470 pg/ml CgA 318 μg/l	No	After 2 days	Nausea, severe diarrhea, metabolic acidosis, hypokalemia dehydration	Fluids i.v., potassium, metoclopramide, octreotide	4 days	3 more cycles of 177Lu-octreotate, with discontinuation of octreotide treatment 1 year later improvement of general condition, less diarrhea and less flushing
4	44/F	VIPoma with liver and bone metastases	2	Streptozine, 5-fluoracil and adriamycine, embolization of liver metastases, lanreotide octreotide, loperamid, potassium	Flushing and diarrhea hypokalemia and dehydration	VIP 710 pg/ml CgA 335 μg/l	Yes	Immediately	Severe diarrhea, metabolic acidosis, hypokalemia, dehydration	Fluids i.v., potassium, octreotide, loperamide, metoclopramide	13 days	2 more cycles of 177Lu-octreotate, with continuation of octreotide and corticosteroids. After the second cycle again hormonal crisis requiring hospitalization. Died after 1 year because of progressive disease
5	50/M	Small intestinal carcinoid with liver metastases	15	Debulking surgery, interferon-alpha, 5-fluorouracil and leucovorin, octreotide LAR	Flushing and diarrhea	CgA 2950 μg/l, urinary 5HIAA 902 μmol/24 h	Yes	Immediately	Nausea, vomiting, flushing, hypotension	Fluids i.v., octreotide, metoclopramide	6 days	6 more cycles of 177Lu-octreotate (half dose, 3,700 MBq) without discontinuation of octreotide. After second cycle, again hormonal crisis requiring hospitalization. Still alive after 2 years, still episodic diarrhea
6	63/M	Malignant pheochromocytoma with lung bone abdominal lymphnode and liver metastases	2	Adrenalectomy, alpha- and beta-adrenergic blockade, octreotide	Nausea	Urinary normetanephrines 79 μmol/24 h, urinary metanephrines 10 μmol/24 h; CgA 6,900 μg/l	No	After 1 day	Hypotension, extensive sweating, cardiac ischemia	Fentolamine, octreotide, bisoprolol, morfine	2 months	3 more cycles 177Lu-octreotate without side effects (with continuation of octreotide and corticosteroids). Died after 1 1/2 years because of progressive disease