Neuroendocrine tumours are therefore a very heterogeneous group arising from these neuroendocrine cells, and include carcinoid, non-carcinoid gastroenteropancreatic tumours (such as insulinoma, gastrinoma and VIPoma (VIP, vasoactive intestinal polypeptide)), catecholamine-secreting tumours (phaeochromocytomas, paragangliomas, ganglioneuromas, ganglioneuroblastomas, sympathoblastoma, neuroblastoma), medullary carcinoma of the thyroid, chromophobe pituitary tumours, small cell lung cancer and Merkel cell tumours.

The Department of Endocrinology at the Hammersmith Hospital is a national centre for the clinical and laboratory investigation of neuroendocrine tumours. The unit's laboratory runs the national supraregional assay service for gut hormones, and an endocrine Consultant, Dr Waljit Dhillo provide the clinical backup for this service. Patients with neuroendocrine tumours are referred from all over the UK and abroad as a consequence of this service. The expertise the Hammersmith Hospital has to offer these patients both with their diagnosis and ongoing management has resulted in a very large cohort of patients with neuroendocrine tumours attending outpatients despite many patients travelling very long distances.

Articles on neuroendocrine tumour management:
MT Barakat, K Meeran and S R Bloom. Neuroendocrine tumours. Endocrine-Related Cancer (2004) 11 1-18

JK Ramage, AHG Davies, J Ardill, N Bax, M Caplin, A Grossman, R Hawkins, AM McNicol, N Reed, R Sutton, R Thakker, S Aylwin, D Breen, K Britton, K Buchanan, P Corrie, A Gillams, V Lewington, D McCance, K Meeran, A Watkinson, on behalf of UKNETwork for neuroendocrine tumours. Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours. Gut. 2005 Jun;54 Suppl 4:iv1-16.

Supraregional gut hormones assay service
The Hammersmith Hospital runs all gut hormone assays for the UK. Assays are available for gastrin, glucagon, VIP, somatostatin, pancreatic polypeptide (PP), neurotensin, chromogranin A and chromogranin B.

• Clinical Use
• Diagnosis of neuroendocrine tumours.

Patient Preparation
With patient at rest after a complete overnight fast, take blood (10 mL) using a syringe and needle. H2 blockers should be stopped for 72h and Omeprazole for two weeks, before blood is taken.

Sample Preparation
Transfer the blood (10 mL) to a commercial heparin tube containing Trasylol (aprotinin, 0.2 mL, 2000 KIU). Mix by inversion. Place on ice and transfer to the laboratory. Separate the plasma in a refrigerated centrifuge. Aliquot known volumes of plasma (preferably into polypropylene tubes, in case of breakage in transit) and freeze at -20oC within 15 minutes of venepuncture. Visible haemolysis invalidates the result.

If from oversease, freeze-dry (lyophilise) the samples in vacuo, until all water content has been completely removed. State clearly and indelibly the patient=s name (in English) and the reconstitution volume of each vial on every sample and also on accompanying forms. Seal in vacuo, or under dry N2. Send by post to the address shown below. Record on the request form the patient's serum calcium and urea levels, a list of all drugs currently administered, details of any gastric surgery the patient has undergone and the basal and stimulated acid output (if available).

Please send samples to:
SAS Reception
G Block
North Corridor
Hammersmith Pathology Centre
Hammersmith Hospital
Du Cane Road
LONDON W12 0HS
Tel: 020 8383 2148

Localisation of neuroendocrine tumours
Neuroendocrine tumours can be localised using CT or MRI scans and octreotide scans. However, in many patients these techniques cannot localise small tumours. Dr James Jackson is a Consultant Radiologist at The Hammersmith Hospital who has extensive experience in the localisation of pancreatic neuroendocrine tumours using visceral angiography and calcium stimulation which is able to confirm the localisation of small tumours not detected by other imaging modalities.

Endocrine Radiology

Jackson JE. Angiography and arterial stimulation venous sampling in the localization of pancreatic neuroendocrine tumours. Best Pract Res Clin Endocrinol Metab. 2005 Jun;19(2):229-39

Dhillo WS, Jayasena CN, Jackson JE, Lynn JA, Bloom SR, Meeran K, Todd JF. Localization of gastrinomas by selective intra-arterial calcium injection in patients on proton pump inhibitor or H2 receptor antagonist therapy. Eur J Gastroenterol Hepatol. 2005 Apr;17(4):429-33.