{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T10:08:24Z","timestamp":1760954904870},"reference-count":55,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2006,9,7]],"date-time":"2006-09-07T00:00:00Z","timestamp":1157587200000},"content-version":"vor","delay-in-days":37,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Annals of the New York Academy of Sciences"],"published-print":{"date-parts":[[2006,8]]},"abstract":"<jats:p><jats:bold><jats:sc>Abstract:\u2002<\/jats:sc><\/jats:bold>  <jats:bold>Catecholamine\u2010secreting metastatic carcinoid should be considered in differential diagnosis of malignant pheochromocytoma. Paroxysmal functioning or hormonally silent gastroenteropancreatic neuroendocrine tumors (GEP NETs) require repeat biochemical measurements and sensitive anatomic and functional imaging studies overlapping those for malignant pheochromocytoma. This report presents clinical, laboratory, and radiologic findings in a patient presenting with heart rate variability; vasoactive headaches reactive to ethanol, tyramine and tryptophan; labile blood pressure; diaphoresis; diarrhea; abdominal pain; unexplained pancreatitis; joint pain; and paroxysmal flushing with pallor. GI studies (including endoscopic ultrasound) and multiple imaging modalities (including 2D CT, MRI with gadolinium, [<jats:sup>18<\/jats:sup>]FDG PET\/CT, [<jats:sup>123<\/jats:sup>I]MIBG, and SRS [<jats:sup>111<\/jats:sup>In]Octreotide [OctreoScan]) were not diagnostic. 24\u2010h BP, Holter and 30\u2010day cardiac event monitors plus urinary biochemical studies consistently suggested catecholamine\u2010synthesizing NET. NIH plasma metanephrines studies and [6]\u2010[<jats:sup>18<\/jats:sup>F]Fluorodopamine PET ruled out malignant pheochromocytoma (pheo). Repeated studies showed persistently abnormal GEP NET biomarkers and urinary catecholamines. Capsule endoscopy revealed suspicious submucosal lesions throughout the small intestine. Dual\u2010phase 64\u2010slice multidetector computed tomography (MDCT) with 3D volumetric reconstruction of the abdomen and pelvis revealed multiple diffuse liver metastases and three extrahepatic lesions consistent with metastatic carcinoid. In combination, intensive biochemical testing repeated over time, dual\u2010phase 64\u2010slice MDCT with 3D image reconstruction and volume\u2010rendering (VR) technique, and advanced radionuclide imaging are required to detect NETs' sporadic or paroxysmal functioning, rule out extra\u2010adrenal pheochromocytoma, and localize and characterize metastatic carcinoid. If pheochromocytoma is ruled out, yet symptoms and biochemical markers for catecholamine excess are present, then carcinoid and other amine\u2010precursor\u2010uptake decarboxylation (APUD) tumors must remain in the differential diagnosis.<\/jats:bold> <\/jats:p>","DOI":"10.1196\/annals.1353.007","type":"journal-article","created":{"date-parts":[[2006,11,14]],"date-time":"2006-11-14T00:28:06Z","timestamp":1163464086000},"page":"59-78","source":"Crossref","is-referenced-by-count":7,"title":["Catecholamine\u2010Secreting Metastatic Carcinoid as Differential Diagnosis in Pheochromocytoma"],"prefix":"10.1111","volume":"1073","author":[{"suffix":"III","given":"HENDRICKS H.","family":"WHITMAN","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"ELLIOT K.","family":"FISHMAN","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"KJELL","family":"\u00d6BERG","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"JOSEPH M.","family":"WILDMAN","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"ANDREA L.","family":"LONG","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2006,9,7]]},"reference":[{"key":"e_1_2_7_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.cco.0000167739.56948.a9"},{"key":"e_1_2_7_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpg.2005.06.002"},{"key":"e_1_2_7_4_2","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1080\/02841860410018502","article-title":"Guidelines for the management of gastroenteropancreatic neuroendocrine tumours (including brochopulmonary and thymic neoplasms). 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