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/

COLD INDUCED URTICARIA

Cause

• Urticaria after exposure to cold temperature, water, weather, cooling after overheated, swimming in cold water, exposure to cold during surgery.
  • It is a chronic inducible form of urticaria that can be precipitated and tested by Cold stimulation test
• Mechanism- this type of urticaria is IgE mediated, the pathophysiology is thought to involve the cold-induced formation of auto allergens and IgE to these auto allergens, which provoke a release of proinflammatory mediators from skin mast cells.

Symptoms

• Appear within minutes of exposure
• Swelling redness – angioedema
• Itching and wheal formation
• In rare cases if airway affected leading to swelling and choking which is emergency condition
• Many other GIT/ cardiovascular effects etc
• Localized reflex cold urticaria: Confined to specific areas. It has been reported to occur after exposure to cold at the sites of previous ragweed injections for allergies or ladybug bites.

Underlying types

• Hereditary or acquired
• Primary/ Idiopathic
  • Autoallergy, autoimmunity, neurogenic pathways and aberrant temperature sensing as underlying mechanism
• Secondary

Various underlying conditions have been recognized to which cold urticaria may be associated. A physician when presented with this type of urticaria should suspect the following conditions as underlying disease rather than simply labelling it as cold urticaria.

• Infectious diseases
  • Chickenpox (varicella)
  • Syphilis
  • Viral hepatitis
  • Infectious mononucleosis (glandular fever) and other respiratory viral infections
  • Other viral and bacterial infections
  • Cancers
    • Lymphoproliferative diseases, Chronic lymphocytic leukaemia, Blood cancers, Lymphosarcoma
  • Insect stings
  • Iatrogenic
    • Intake of certain drugs or foods
  • Immune
    • Cryoglobulinemia
    • Immunisations.

D/D

urticaria on exposure to cold or cold exposure related diseases

• Familial cold autoinflammatory syndrome (FCAS) or familial cold urticaria
• PLAID: PLC-gamma-2-associated antibody deficiency and immune dysregulation– Symptoms include hives triggered by evaporative cooling (like exposure to cold air or wind) rather than direct contact with cold objects or water. 
• Cold-dependent dermatographism
• Cryoglobunemia
• Paroxysmal cold haemoglobinuria

Materia Medica

Rhus tox and Dulcamara are the two classical remedies listed for this type of urticaria. The new repertories list many more medicines other than these two. In author’s practice this urticaria is not as uncommon as is purported by medical literature. Even long standing cases respond quickly and are easily amenable to homeopathic treatment with complete resolution. None of the cases were found to have underlying condition, despite detailed case evaluation. Nevertheless, it is always recommended to keep looking for the starting point of condition (Most probable cause/ exciting cause/ ailment from ) as sometimes patient forget the precipitating event as it happened long back in the past, making the condition chronic in its temporal dimension.

Case of urticaria treated with RHUS TOX

RHUS TOX

Pulford keynotes

• Urticaria after becoming wet.

DULCAMARA

Allen’s Key notes

• Skin is delicate, sensitive to cold, liable to eruptions, especially urticaria; every time patient takes cold or is long exposed to cold

The Encyclopedia of Pure Materia Medica

• Stinging, prickings in different parts of the skin of the neck, on walking in the (open) after drinking cold water.

Repertories

Kent repertory

• Skin, urticaria
  • Cold bath after- CALC PHOS
    • From taking- DULC

Complete repertory

• Eruptions urticaria, nettle rash
  • Air cold agg- ARS, CAUST, DULC, KALI BROM, NAT SULPH, NIT AC, RHUS TOX, RUMEX, SEP, SULPH
  • Becoming cold- ARS CALC, CAL PHOS, CHLORALUM, DULCAMARA, RHUS TOX, RUMEX, SEP, SULPH, THUJA
  • Cold agg- APIS, ARS, BELL, CALC, PHOS, CAUST, DULC, KALI BROM, NAT SULPH, NIT AC, RHUS TOX, RUMEX, SEP, SULPH
  • Wet getting after- CHLORALUM, RHUS TOX

Reference

• https://rarediseases.org/rare-diseases/urticaria-cold/
• www.sciencedirect.com
• https://pubmed.ncbi.nlm.nih.gov
• Complete Dynamis
• Kent Repertory
• Boericke Materia Medica and Repertory
• The Encyclopedia of Pure Materia Medica- T. F. Allen
• Allen’s Keynotes
• Pulford Keynotes

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/

PTSD

Post traumatic stress disorder is a constellation of condition that arises in response to exposure to traumatic event or series of traumatic events such as

• Exposure to actual or threatened death,
• Serious injury, or sexual violence
• Or chronic, constant, threatening exposure to violence causing constant concern for safety and life.
• Natura disaster/ war
• Abuse (sexual, emotional, physical)

The trauma can be either

• Directly experiencing by the person,
• Witnessing a person experiencing trauma,
• Or learning that the traumatic event occurred to a close family member or friend.

Following the trauma the processing of traumatic event is affected in the brain and the trauma maintains its intensity in the memory as it first happened, modifying cognition, mood, causing somatic experiences, and behaviour changes, leading to chronic impairments and an increased risk of comorbid psychiatric illnesses and susceptibility to suicide. 

Presentation includes but is not limited to:

• Intrusive memories or nightmares
• Avoidance behaviours
• Negative changes in mood and cognition,
• Heightened arousal.
• Dissociative symptoms 
• Recurrent, involuntary, and intrusive thoughts associated with the traumatic event.
• Flashbacks, in which the individual may feel or act that the traumatic event is happening again.
• Marked physiological reactivity such as increased heart rate and blood pressure on exposure to traumatic reminders

SPONGIA

The following symptomatology indicates that SPONGIA can be one of the leading remedies for the above-mentioned presentation of PTSD. Each of the following symptoms can be corelated with the phenomenon of PTSD.

From various sources:

• Anxiety with feeling as if will die or suffocate
• Anxiety in sleep, wakes up sudden anxious and sudden, with sense of suffocation, violent loud cough, great alarm agitation, anxiety and difficult respiration
• Inclination to weep during sleep

Clarke (A Dictionary of Practical Materia Medica)

• Rouses up in sleep as if in a great fright.
• She is very timid, and is esp. pursued and incessantly tormented by a frightful scene of some mournful event of the past
• < When thinking of her symptoms.
• Sad, anxious, frightful dreams
• Excessive moral and physical dejection.
• Attacks of heat with anxiety; heat and redness of face and perspiration.

The Encyclopaedia of Pure Materia Medica

• Anxiety, as if a misfortune would befall him, which he seemed to foresee, she is very fearful, and tormented by a frightful image of a past sad event. She was very easily frightened, and started at every trifle; it always seemed that fear shoot into her feet, and afterwards they seemed to remain heavy,

This kind of presentation can also cover following disorders

D/D

• Generalized anxiety disorder
• Panic attacks
• Sleep disorders or parasomnias

(Many medicines esp. ones which cover AILMENTS FROM FRIGHT/ FEAR will be useful in PTSD and related conditions. Each drug behaves differently when faced with a situation. The final remedy selection depends on this reaction and presentation of patient, its PQRS and analysis by the physician.)

Some Rubrics from Complete Dynamis Repertory, that can be used in PTSD

• Fright Fear, agg, ailments from
  • Accident from site of an
  • Mental and emotional consequences
  • Prolonged

etc

Reference

• https://www.ncbi.nlm.nih.gov
• https://www.psychiatry.org/
• https://www.who.int/
• The Encyclopaedia of Pure Materia Medica by T F Allen
• A Dictionary of Practical Materia Medica by Clarke
• Boericke Materia Medica
• The Guiding Symptoms of Our Materia Medica by Hering
• Complete Dynamis Repertory

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.

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 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/

Presentation

• Gelastic seizure or laughing seizures are spells of unmotivated laughter. The patient has short interval episodes of involuntary laughter.
• These unprovoked, out of context episodes are perceived as bizarre by people around.
• There is no social context or external trigger for the laughter and happen with no related emotion such as joy or sadness.
• The patient may or may not remember the laughter spell. There may be post ictal confusion.

Etiology

• These seizures indicate presence of Hypothalamic Hamartomas most of the times.
• Some cases have been reported in literature with temporal lobe or frontal lobe as foci of pathology such as tumors, post infectious foci or malformations giving rise to gelastic seizure.
• These are non-cancerous, nonprogressive lesion lesions in hypothalamus and are essentially abnormal tissue development in foetus

Associated features

• Hypothalamic hamartomas may also be associated with developmental delays, aggression, precocious puberty etc.
• Many behavioural and psychiatric symptoms are relatively common such as oppositional defiant disorder, attention-deficit/hyperactivity disorder, conduct disorder, and mood disorder in patients with hypothalamic hamartomas.

D/D

A wider variety of conditions can produce involuntary laughter pseudobulbar effect, which can happen after injuries to brain, in multiple sclerosis or even dementia.

In our Materia Medica this will be addressed by changeability or even laughter alternating with sadness etc.

Agaricus muscaris

A remedy which closely resembles gelastic seizure in its pathogenesy. Below are the different symptoms from various sources mentioned to point towards the similarity between the disease and the drug.

Hering

• Gaping: followed each time by involuntary laughter; makes him giddy; and sneezing, with pain in maxillary joint; with stretching, most of arms; and shaking chill.
• During violent shaking chill, after undressing in evening, a peculiar inclination to laugh.
• Morose, self-willed, stubborn, slow in learning to walk; and talk; on trying to walk; stumbled singularly often.

The Encyclopaedia of Pure Materia Medica

• Several convulsions followed each other in quick succession, first in posterior part of the chest, then in the epigastrium, afterwards in the hypogastrium, especially on the right side, attended with a sensation as if the whole body was shaken through; in the evening when standing.
• Epilepsy. In patients with epilepsy the fits came on at short intervals.
• He yawned frequently and each yawn was followed by involuntary laughter. An impulse to laugh came over in bed, owing to an indiscernibly mixed sensation of happiness and misery.

Boericke

• Laughing involuntary from pressure of spine.
• Yawning followed by involuntary laughter.

D/D- In complete repertory many other medicines are given, such as- AGAR, BORAX, AURUM, CANN IN, IGNATIA, NAT MUR, PHOS, SEPIA, TARENTULA

In summary Gelastic seizures require careful evaluation for underlying neurological conditions like hypothalamic hamartomas. From a homeopathic standpoint, Agaricus Muscarius stands out as a close remedy due to its unique symptoms of involuntary laughter, convulsions, developmental and behavioural, and emotional disturbances aligning well with the clinical picture of gelastic seizure.

References

• The Guiding Symptoms of Our Materia Medica by Hering
• Boerick’s Materia Medica
• The Encyclopedia of Pure Materia Medica by T F Allen
• Complete Repertory
• www.medscape.com
• www.sciencedirect.com
• https://www.ncbi.nlm.nih.gov/books/NBK560663/

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.

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 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/