Related Experiment Video
Updated: May 12, 2026

Robotic Enucleation of an Intra-Pancreatic Insulinoma in the Pancreatic Head
Published on: January 3, 2020
Sunitinib-induced hyperammonaemia in a patient with pancreatic neuroendocrine tumour
Y-f Shea1, W-y J Chiu, M-y M Mok
1Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China. elphashea@gmail.com
What Is Known And Objective:
Sunitinib can improve progression-free survival and overall survival in patients with advanced pancreatic neuroendocrine tumor (PNET). From clinical trial, most commonly reported adverse events of sunitinib were neutropenia (12%), diarrhea (10%), asthenia (7%), erythrodysesthesia (7%), hypertension (7%) and thrombocytopenia (6%).
Case Summary:
We report a patient with PNET with liver metastases who developed hyperammonemia with a low dosage of sunitinib probably contributed by the presence of liver metastases.
What Is New And Conclusions:
We would like to draw attention to the potential risk of sunitinib induced hyperammonemic encephalopathy even with a low dosage of sunitinib. The absence of sunitinib-induced hyperammonemia during its initial course does not rule out this possibility if there is increased in liver metastases. We suggest checking the ammonia level if patient on sunitinib presented with altered sensorium even if the liver function is normal.
Related Concept Videos
Chemotherapy-Induced Nausea and Vomiting: Neurokinin-1 Receptor Antagonists
Hepatic Encephalopathy
Acute Pancreatitis II: Pathophysiology
Pharmacogenetics of Phase II Enzymes: N-acetyltransferase, Thiopurine S-methyltransferase, UDP-glucuronosyltransferase
Acute Pancreatitis II: Clinical Manifestations and Management