Dr When you hear hoofbeats sometimes it's Zebra

A case of pancreatic neuroendocrine carcinoma

Abstract

In medicine, the term "zebra" is used for a rare disease or condition, like neuroendocrine tumors (NET). Medical students are thought to assume that the simplest explanation is usually the best, i.e., it is usually correct to look for common rather than exotic causes for the disease. Doctors learn to expect common conditions, hence the riddle “If you hear hoofbeats, think horses, not zebras.” But zebras do exist, and the unlikely NET can and does sometimes occur. NET is often presented with symptoms of far more common illnesses such as Crohn’s Disease, irritable bowel syndrome, asthma, and rosacea. When diagnosing patients who present with varying symptoms, we doctors need to remember that when they hear hoofbeats it could also be a Zebra. This is a case of a 56yr female presenting with diarrhea. On evaluation, she was found to have a pancreatic tumor with metastasis to the liver. Biopsy from the hepatic metastasis confirmed neuroendocrine carcinoma and diarrhoeal episodes decreased with octreotide. Further treatment options were explored and started on cisplatin-etoposide-based chemotherapy.