Abstract
In viral pandemics, most specifically Covid-19, many patients with neuroendocrine neoplasms (NENs), including phaeochromocytomas, paragangliomas and medullary thyroid carcinoma, may develop Covid-19 in a mild or severe form, or be concerned about the influence of viral infection relative to their anti-tumoral therapy. In general, newly presenting patients should be assessed, and patients recently receiving chemotherapy, targeted therapy or radionuclide therapy, or showing tumour growth, should be closely followed. For previously diagnosed patients, who have indolent disease, some delay in routine follow-up or treatment may not be problematic. However, patients developing acute secretory syndromes due to functional neuroendocrine neoplasms (such as of the pancreas, intestine or lung), phaeochromocytomas and paragangliomas, will require prompt treatment. Patients with life-threatening Covid-19-related symptoms should be urgently treated and long-term anti-tumoral treatments may be temporarily delayed. In patients with especially aggressive NENs, a careful judgement should be made regarding the severity of any Covid-19 illness, tumour grade, and the immunosuppressant effects of any planned chemotherapy, immunotherapy (e.g. interferon-alpha), targeted therapy or related treatment. In other cases, especially patients with completely resected NENs, or who are under surveillance for a genetic disorder, a telephone or delayed consultation may be in order, balancing the risk of a delay against that of the possible development of Covid-19.
Highlights
SARS CoV2 viruses (Covid-19) bind to angiotensinconverting enzyme-2 (ACE2), a cell-surface receptor, and a potential interaction between Covid-19 and the renin-angiotensin-aldosterone system has been reported [1, 2, 3, 4]. Such interactions between Covid-19 or other SARS viruses and receptors expressed on neuroendocrine neoplasms (NENs), such as somatostatin receptors (SSRs) and histamine receptors (H1 and H2 receptors), have not been reported
Neuroendocrine neoplasms (NENs) are rare neoplasms arising from cells of the diffuse endocrine system, mainly dispersed throughout the digestive system and respiratory tract
Some patients presenting with Covid-19 infection may have an underlying undiagnosed NEN, and this possibility should be considered in those patients whose symptoms, for example, diarrhoea, or wheeze with shortness of breath, are not resolving, or whose symptoms were chronic
Summary
SARS CoV2 viruses (Covid-19) bind to angiotensinconverting enzyme-2 (ACE2), a cell-surface receptor, and a potential interaction between Covid-19 and the renin-angiotensin-aldosterone system has been reported [1, 2, 3, 4]. Patients with NENs and severe infections causing respiratory difficulties or gastrointestinal (GI) symptoms (e.g. diarrhoea, nausea and vomiting) are likely to present to hospital.
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