This article is an attempt to correlate symptomatic corelation of AMYL NITROSUM with pathophysiology of NEUROENDOCRINE TUMORS and is yet to be seen by author in practice.
NEUROENDOCRINE TUMORS
Def:  originating from chromaffin cells in the adrenal medulla in case of pheochromocytomas while GIT is the main site for carcinoid tumors.
Release of hormones in response to nervous stimuli.
Eg are- Pheochromocytoma, Carcinoid tumor, Islet cell tumor and some lung cancer like Small Cell CA, Merkel cell carcinoma etc.
PHEOCHROMOCYTOMAS
- Hormones involved
- Overproduction of catecholamines (group of hormones and neurotransmitters maintaining homeostasis and regulating the body’s response to stress eg dopamine, norepinephrine, and epinephrine).
- Characteristic-
- Sporadic or familial
- Benign or malignant
- Often associated with familial syndromes such as neurofibromatosis type 1, multiple endocrine neoplasia type 2, and von Hippel-Lindau disease.
- Triggers for catecholamine release
- Mechanical factors such as abdominal palpation, sexual intercourse, coughing, sneezing, defecation,
- Pain,
- Extreme emotions, and
- Exposure to cold
- Clinical Features
- Release of hormone from tumor can be- paroxysmal, continuous, or mixed.
- Norepinephrine is typically released continuously, leading to persistent hypertension, while epinephrine is released in a paroxysmal manner.
- Episodes of hypertension associated with symptoms such as headaches, tachycardia, and sweating.
- Presence of hypertension that is resistant to multiple antihypertensive therapies should raise suspicion for pheochromocytoma
- Most commonly overlooked causes of secondary hypertension
- Abdominal pain
- Constipation
- Chest pain
- Dizziness
- Elevated blood sugar
- Facial flushing (redness)
- Increased respiratory rate
- Nausea
- Nervousness, anxiety, and irritability, sense of doom
- Pale skin tone, Pallor
- Rapid heart rate and heart palpitations
- Severe headaches
- Sweating, Diaphoresis
- Visual disturbances
- Weight loss
- Tremor
- Weakness
- Epigastric pain
- Flank pain
- Weight loss
- axillae and intertriginous areas.. café au lait spots
- Typically spells characterized by headaches, palpitations, and diaphoresis in association with severe hypertension.
CARCINOID
- Hormones involed and location- neuroendocrine tumors, most commonly arising from the GIT characterized by the secretion of serotonin, leading to symptoms, eg, flushing, diarrhoea, bronchospasm, and systemic complications
- Characteristic
- Sporadic or familial
- Small or bulky
- Trigger
- Spontaneous
- Triggered by certain factors, eg, eating, alcohol consumption.
- Liver palpation, or anesthesia.
- Exercise, stress, or emotional stress
- Certain foods (eg, cheese) may trigger an attack.
- Clinical Features
- Flushing- Sudden episodes of salmon-pink characterize it to dark-red discoloration of the upper body, particularly the face, neck, and upper trunk, associated with an unpleasant warm feeling, itching, rash, sweating, palpitation tachycardia, swelling around the eyes, and increased lachrymation.
- Episodes lasting anywhere from 30 seconds to 30 minutes
- Periodic abdominal pain
- Valvular heart lesions
- Cough dyspnoea or asthma like symptoms from bronchoconstriction
- Watery, frothy Diarrhoea and malabsorption or bulky stools, gastrointestinal (GI) bleed or fat in stool
- Abdominal cramps
- Lengthening duration of attack from initially few minutes to later few hours to even constant flushing in some cases.
DIFFERENTIAL DIAGNOSIS, D/D of Pheochromocytomas and Carcinoid tumor
- Anxiety disorder
- Hypoglycaemia
- Panic attack
- Angina
- Thyrotoxicosis
AMYL NITROSUM
(https://drshivangihomoeopathy.com/?s=amyl)
- Facial flushing is a grand concomitant of this remedy and accompanies almost all the symptoms.
- Congestion as generality
- Acute or chronic
- Rush and Congestion of blood to head and face
- Flushing and then hot sweat, all over the body or in parts
- Localized flushings
- Other parts may be icy cold
- Least emotions cause flushing of face (FERRUM, COCA) (From the slightest emotion flushing of the face- Hering Guiding Symptoms)
- Throbbing and pulsations
- Craves fresh air, opens the window in the coldest of the weather (SULPH, LACHESIS, ARGENTUM NITRICUM)
- Can’t bear anything around neck, loosens collar
- Constant stretching and yawning (KALI CARB)
- Convulsions
- Immediately after delivery
- Paroxysms run close to each other
- Grasping at imaginary things during convulsions
- Chorea, all muscles are in motion
- Angina
- With facial flushings
- With pain in rt shoulder and arm
- Sensation of band around chest
- Choking in throat, pain extending into chest
- Fluttering and tumultuous action of heart at slightest excitement
- Headache
- Dreamy confounding with headache
- Flushing of face with headache
- Migraine with pallor (ARS)
- Aggravations
- emotions
- slight causes
- climacteric
- heat and closed room
DIFFERENTIAL MATERIA MEDICA
- GLONINE
- BELLADONNA
- LACHESIS
- ACONITE
COMPARISON of manifestation
A close comparison of the symptoms the Neuroendocrine tumors sp pheochromocytoma and carcinoid tumors show that AMYL NITROSUM very closely covers the main symptoms of both the conditions sp flushings diarrhoea headache and also triggers such as agg from emotional causes etc.
This is comparison of the most prominent features, further detailed study reveals the parallels between the manifestation in the disease and the medicine AMYL NITROSUM.
Few prominent comparisons are given below:
- Intense surging of blood to the face and head, heat and redness; feels as if the blood would start through the skin, with lachrymation. Intense redness of surface with great subjective feeling of heat in face and head. Left side of face and 1. ear get intensely red, coming suddenly and disappearing suddenly during the intervals of the attacks of headache; most after mental symptoms- Hering Guiding Symptoms.
- Face, and even the back of the hands, deeply reddened- Hering Guiding Symptoms
- Flushing- Sudden episodes of salmon-pink characterize it to dark-red discoloration of the upper body, particularly the face, neck, and upper trunk, associated with an unpleasant warm feeling, itching, rash, sweating, palpitation tachycardia, swelling around the eyes, and increased lachrymation.
| Feature | Pheochromocytoma/Carcinoid | Amyl Nitrosum |
| Flushing | Episodic, emotional triggers | Sudden, emotion-induced |
| Tachycardia | Paroxysmal, stress-related | Palpitations, tumultuous heart |
| Sweating | Common in spells | Hot sweat following flushing |
| Emotional aggravation | Prominent trigger | Marked aggravation |
RUBRIC SUGGESTION
COMPLETE DYNAMIS
Face
Redness
Asthmatic complaints with- ACO, CAPS, THUJA
Diarrhoea with- FERR PHOS, JABORANDI
Hypertension in- STRONTIUM CARB
Pulsation about heart with- AMYL NITROSUM,
KENT REPERTORY
Face
Discolouration
Red
Many remedies are given under this rubric
BELL, GLONINE and ACONITE are other medicines which come very close to AMYL NITROSUM in repertorial analysis of symptoms of NET’s.
The final selection of the remedy is just not a pathological similimum but covers the whole history of the patient (anamnesis) with its PQRS, concomitants aggravations and particulars. The angle of prescription depends on many factors.
REFERENCES
- Kent Repertory
- Boericke Materia Medica and Repertory
- The Encyclopedia of Pure Materia Medica- T. F. Allen
- Hering Guiding Symptoms
- Allen’s Keynotes
- Complete Dynamis
- Harrison’s Principles of Internal Medicine
- https://emedicine.medscape.com
- https://www.ncbi.nlm.nih.gov/books/NBK448096/
- https://www.ncbi.nlm.nih.gov/books/NBK589700/
- https://www.cancer.gov/pediatric-adult-rare-tumor/rare-tumors/rare-endocrine-tumor/carcinoid-tumor#:~:text=Other%20Rare%20Tumors-,Neuroendocrine%20Tumor%20(NET),as%20pain%20in%20the%20abdomen.
NB: This similarity is found only while studying the medicine from a pathological point of view. The confirmation can only be done by applying this knowledge in such a clinical condition, in a patient.
A similar pathogenetic condition may also be present in another drug, the differentiation between such drugs in similar pathologic condition is what makes homoeopathy an individualistic medicine.
This kind of approach is especially helpful when:
- The patient is not able to give refined symptoms and sensations
- One is not able to find any characteristic symptom or
- The attendants are not able to give one,
- There is time constraint or
- The physician has not seen the patient but has received a diagnosis from attendants.
- Pathology is advanced enough to wipe out the PQRS of the case.
- The patient has taken conventional treatment masking or modifying the individualistic feature. (Refer to Organon of Medicine for treatment of such cases)
The results in such prescriptions would nonetheless depend on the accuracy of diagnosis and its pathological similarity to chosen medicine.
(This post is for the practitioners of Homoeopathy and not for patients for diagnosis and treatment of the said entity.)
Aude Sapere
Shivangi Jain
BHMS, MD, PGDMLE, PGDHHM
drshivangijain79@gmail.com
https://drshivangihomoeopathy.com/