Scott Weerasuriya

Lewisham and Greenwich NHS Trust

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Rajaventhan Srirajaskanthan

King's College Hospital

Kieran Palmer

King's College London

Kandiah Chandrakumaran

Basingstoke and North Hampshire Hospital

Benjamin White

Ithaka Harbors

John Ramage

Basingstoke and North Hampshire Hospital

Sangeeta Paisey

Hampshire Hospitals NHS Foundation Trust

Ben Whitelaw

King's College Hospital NHS Foundation Trust

Ahmed Bobo

King's College Hospital NHS Foundation Trust

Vishal Salota

Lewisham and Greenwich NHS Trust

Yousaf Bhatti

Royal Brompton Hospital

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King's College Hospital NHS Foundation Trust

National Health Service

King's College Hospital

King's College London

Kings Health Partners

University of Cambridge

Hampshire Hospitals NHS Foundation Trust

Chelsea and Westminster Hospital NHS Foundation Trust

King's College - North Carolina

University College London

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Posterior reversible encephalopathy syndrome in a patient with a metastatic pancreatic neuroendocrine tumour and ectopic Cushing’s syndrome

Endocrinology Diabetes and Metabolism Case Reports (2021)

Kieran Palmer Scott Weerasuriya Ben Whitelaw Rajaventhan Srirajaskanthan

Summary We report a rare case of posterior reversible encephalopathy syndrome (PRES), precipitated by ectopic Cushing’s syndrome, in a patient with a metastatic pancreatic neuroendocrine tumour. A 55-year-old female presented as a hypertensive emergency with seizures and severe biochemical disturbance, including alkalosis, hypokalaemia and hyperglycaemia. MRI showed vasogenic oedema in the parieto-occipital region, consistent with a diagnosis of PRES. She had a significantly raised serum cortisol (>6000 nmol/L) which did not suppress with dexamethasone. Plasma adrenocorticotropic hormone (ACTH) concentrations were neither suppressed nor raised but were consistently within the normal reference range. The unexpected finding of a normal ACTH may be explained by either tumour secretion of unmeasured ACTH-related peptides, immunoassay antibody interference or episodic ACTH secretion. PRES is usually reversible with prompt and appropriate treatment. Hypercortisolism associated PRES is rare and may be associated with a worse outcome. Learning points PRES secondary to ectopic Cushing’s syndrome is very rare. PRES in this context may indicate a worse prognosis. In ectopic Cushing’s syndrome, if the serum ACTH level is normal, consider testing for ACTH-related peptides or interfering antibodies. Further research is required to establish the best treatment approach and to improve patients’ outcomes.

Posterior pituitary

10.1530/edm-21-0014

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Citations (3)

Mesenteric Variceal Haemorrhage and Ectopic Cushing’s Syndrome as Presenting Features of a Pancreatic Neuroendocrine Tumour Recurrence

Case Reports in Gastroenterology (2021)

Scott Weerasuriya Kieran Palmer Stephen Gregory Ben Whitelaw Elisa Gonzalez

Pancreatic neuroendocrine tumours can have varied and complex presentations. Whilst hormone hypersecretion often induces characteristic clinical syndromes, non-specific symptoms may arise due to localized tumour effects. Malignant invasion of local vasculature is an increasingly recognized complication of these neoplasms and can be associated with significant morbidity. Herein, we present the case of a 47-year-old male with a recurrence of a pancreatic neuroendocrine tumour who presented with unusual upper gastrointestinal bleeding. The tumour had recurred within the superior mesenteric vein, replacing the vessel and invading its branches. This resulted in porto-mesenteric hypertension and the formation of bleeding mesenteric varices. The patient subsequently developed progressive metabolic disturbances and was diagnosed with ectopic Cushing's syndrome, despite his primary tumour having been non-functional. This case demonstrates not only a rare pattern of tumour recurrence but also the potential for pancreatic neuroendocrine tumours to de-differentiate and change from non-functional to hormone secreting, a phenomenon which may complicate diagnosis and management.

Neuroendocrine tumour

10.1159/000518021

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Primary renal neuroendocrine neoplasms: A systematic literature review, report of four local cases, and original survival analysis of 63 patients from a national registry 2012–2018

Journal of Neuroendocrinology (2022)

Sangeeta Paisey Scott Weerasuriya Kieran Palmer Benjamin White Rajaventhan Srirajaskanthan

Primary renal neuroendocrine neoplasms (NEN) are rare. We aimed to conduct a systematic review, present local cases, and analyse data from the England's National Cancer Registration and Analysis Service (NCRAS) to provide comprehensive evidence on clinical experience, incidence, and survival to better characterize these tumours. First, a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method; second, a synthesis of local cases; and, finally, a retrospective population-based cohort analysis of renal NEN recorded between 2012 and 2018 on NCRAS were performed. Kaplan-Meier estimator was used to calculate overall survival and Cox proportional hazard regression to identify prognostic factors. Systematic review identified 48 articles and the evidence was summarized and presented. We reported data from four local cases presenting with abdominal and back pain but without carcinoid syndrome. In population-based analysis, we identified 63 cases of renal NEN between 2012 and 2018 from the registry. Age-standardized incidence was 0.09-0.32 per million with a median age of 64 years (interquartile range = 48-72 years). Survival was worse in males and those aged 64 years and over. Five-year survival for renal neuroendocrine tumours (NET) was 69.8% (95% confidence interval = 66.6-72.7) and neuroendocrine carcinomas (NEC) was 38.4% (95% confidence interval = 34.6-42.0). No independent predictive factor was identified in the multivariable analyses. We have given a systematic review of evidence, published local experience, and reported incidence and survival of renal NEN in England for the first time. We have provided clinicians with evidence on diagnosis and proposed a treatment algorithm of theses rare tumours. The incidence and median age of presentation in England is similar to other published series. Renal NET has better survival than renal NEC as expected. A uniform classification system would reduce inconsistencies in reporting and standardize treatment decisions for this neoplasia.

Interquartile range

Carcinoid tumour

10.1111/jne.13215

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Evaluating the use of the respiratory-rate oxygenation index as a predictor of high-flow nasal cannula oxygen failure in COVID-19

Acute and Critical Care (2023)

Scott Weerasuriya Savvas Vlachos Ahmed Bobo Namitha Birur Jayaprabhu Lauren Matthews

It can be challenging for clinicians to predict which patients with respiratory failure secondary to coronavirus disease 2019 (COVID-19) will fail on high-flow nasal cannula (HFNC) oxygen and require escalation of therapy. This study set out to evaluate the association between the respiratory rate-oxygenation index (ROX) and HFNC failure in such patients and to assess whether ROX trajectory correlates with treatment failure.

Nasal cannula

Pulse Oximetry

Oxygen Saturation

Respiratory Rate

Oxygen therapy

10.4266/acc.2022.01081

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Reducing avoidable chest pain admissions and implementing high-sensitivity troponin testing

BMJ Open Quality (2019)

Yousaf Bhatti Alexander J. Stevenson Scott Weerasuriya Sadia Khan

NHS accident and emergency departments see 0.5 million patients presenting with a cardiac condition each year. The accurate assessment of chest pain and subsequent diagnosis or exclusion of myocardial infarction (MI) represent a significant challenge, with important consequences on patient outcome and healthcare resources. We conducted a cross-sectional analysis of patients admitted with cardiac chest pain to a busy district general hospital in London. The criteria used by physicians to admit patients for further cardiac investigations were measured against national guidance on chest pain assessment and diagnosis of MI. We found that poor adherence to guidance, unsuitable patient pathways and inappropriate diagnostic tools at the point of presentation led to unnecessary inpatient admissions to the hospital. Quality improvement methods were used with the aim to reduce avoidable admissions to hospital in patients presenting with chest pain. We describe a system to implement new high-sensitivity troponin testing into legacy chest pain pathways. This was achieved through local education of National Institute for Health and Care Excellence (NICE) guidance, the use of patient pro formas and the creation of two new chest pain pathway arms to enable physicians to streamline patients for appropriate inpatient or outpatient care. As a result of these changes, we reduced non-compliance with NICE guidance by 83% and achieved a 42% reduction in avoidable chest pain admissions. Overall, the improvements made by this project were sustained over 2 years and saved £21 000 per month in avoidable admissions.

Nice

Excellence

Triage

10.1136/bmjoq-2019-000629

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Citations (4)

Asystolic cardiac arrest secondary to sugammadex administration in a young patient

Anaesthesiology Intensive Therapy (2024)

Scott Weerasuriya Dale Seddon Vishal Salota

AMA Weerasuriya S, Seddon D, Salota V. Asystolic cardiac arrest secondary to sugammadex administration in a young patient. Anaesthesiology Intensive Therapy. 2024;56(2):160-163. doi:10.5114/ait.2024.141235. APA Weerasuriya, S., Seddon, D., & Salota, V. (2024). Asystolic cardiac arrest secondary to sugammadex administration in a young patient. Anaesthesiology Intensive Therapy, 56(2), 160-163. https://doi.org/10.5114/ait.2024.141235 Chicago Weerasuriya, Scott, Dale Seddon, and Vishal Salota. 2024. "Asystolic cardiac arrest secondary to sugammadex administration in a young patient". Anaesthesiology Intensive Therapy 56 (2): 160-163. doi:10.5114/ait.2024.141235. Harvard Weerasuriya, S., Seddon, D., and Salota, V. (2024). Asystolic cardiac arrest secondary to sugammadex administration in a young patient. Anaesthesiology Intensive Therapy, 56(2), pp.160-163. https://doi.org/10.5114/ait.2024.141235 MLA Weerasuriya, Scott et al. "Asystolic cardiac arrest secondary to sugammadex administration in a young patient." Anaesthesiology Intensive Therapy, vol. 56, no. 2, 2024, pp. 160-163. doi:10.5114/ait.2024.141235. Vancouver Weerasuriya S, Seddon D, Salota V. Asystolic cardiac arrest secondary to sugammadex administration in a young patient. Anaesthesiology Intensive Therapy. 2024;56(2):160-163. doi:10.5114/ait.2024.141235.

Sugammadex

10.5114/ait.2024.141235

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Citations (2)

Goblet Cell Adenocarcinoma of the Appendix: A Systematic Review and Incidence and Survival of 1,225 Cases From an English Cancer Registry

Frontiers in Oncology (2022)

Kieran Palmer Scott Weerasuriya Kandiah Chandrakumaran Brian Rous Benjamin White

Goblet cell adenocarcinoma (GCA) of the appendix is a rare and aggressive tumour with varying nomenclature and classification systems. This has led to heterogeneity in published data, and there is a lack of consensus on incidence, survival, and management.We provide an overview of GCA with a comprehensive systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology and a retrospective analysis of all cases recorded in the English National Cancer Registration and Analysis Service database between 1995 and 2018. The Kaplan-Meier estimator was used to calculate overall survival, and Cox proportional hazards regression was used to identify prognostic factors.The systematic review demonstrated an incidence of 0.05-0.3 per 100,000 per year among North American registry studies. The 1-, 3-, and 5-year survival rate was 95.5%, 85.9%-87.6%, and 76.0%-80.6%, respectively. Age, stage, and grade were identified as prognostic factors for survival. Our analysis included 1,225 cases. Age-standardised incidence was 0.0335 per year in 1995 and gradually rose to 0.158 per year in 2018. The 1-, 3-, and 5-year survival rate was 90.0% [95% confidence interval (95% CI): 85.4-94.0], 76.0% (95% CI: 73.8-80.9), and 68.6% (95% CI: 65.9-72.2), respectively. On univariate Cox regression analyses, female sex, stage, and grade were associated with worse overall survival. On multivariate analysis, only stage remained a statistically significant prognostic factor.GCA of the appendix is rare, but incidence is increasing. We report a lower incidence and survival than North American registry studies. Higher stage was associated with decreased survival. Further prospective studies are required to establish optimal management.

10.3389/fonc.2022.915028

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Citations (26)