Carcinoid syndrome
Background
- Carcinoid tumors are neuroendocrine malignancies
- Primary tumors can be located in:[1]
- Gastrointestinal tract (55%)
- Bronchopulmonary system (30%)
- Other sites rarer or may actually be metastases (ovary, liver, gallbladder, thymus, middle ear)
- Syndrome results from tumor production of serotonin, histamine, bradykinin, kallikrein, and/or prostaglandin
Clinical Features
- Vasodilation
- Due to increased histamine and kinin production
- Cutaneous flushing
- Hypotension, vasodilatory shock
- Diarrhea
- Bronchospasm
- Cardiac valvular lesions
- Due to serotonin-stimulated fibroblast growth/fibrogenesis
- Can cause tricuspid or pulmonary regurgitation or stenosis, right heart failure more common than left
Differential Diagnosis
Acute allergic reaction
- Allergic reaction/urticaria
- Anaphylaxis
- Angioedema
- Anxiety attack
- Asthma exacerbation
- Carcinoid syndrome
- Cold urticaria
- Contrast induced allergic reaction
- Scombroid
- Shock
- Transfusion reaction
Related to Local Tumor Effects
- Malignant airway obstruction
- Bone metastases and pathologic fractures
- Malignant spinal cord compression
- Malignant Pericardial Effusion and Tamponade
- Superior vena cava syndrome
Related to Biochemical Derangement
- Hypercalcemia of malignancy
- Hyponatremia due to SIADH
- Adrenal insufficiency
- Tumor lysis syndrome
- Carcinoid syndrome
Related to Hematologic Derangement
Related to Therapy
- Chemotherapy-induced nausea and vomiting
- Cytokine release syndrome
- Chemotherapeutic drug extravasation
- Differentiation syndrome (retinoic acid syndrome) in APML
- Stem cell transplant complications
- Catheter-related complications
- Tunnel infection
- Exit site infection
- CVC obstruction (intraluminal or catheter tip thrombosis)
- Catheter-related venous thrombosis
- Fracture of catheter lumen
- Oncologic therapy related adverse events
Evaluation
- Evaluation to rule out other causes of shock, diarrhea, etc.
- 24 hour urinary HIAA (5-hydroxyindoleacetic acid)
- Echocardiography
- Imaging to locate the tumor, if not known
Management
- Treat shock and right heart failure
- Octreotide
- Antihistamines
Disposition
See Also
External Links
References
- Strosberg, JR. Clinical charecteristis of carcinoid tumors. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on August 20, 2016.)
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