Carcinoid Syndrome
OVERVIEW
Carcinoid tumors are neuroendocrine malignancies typically located in the GI tract; most commonly in the terminal ilium and appendix.
PATHOPHYSIOLOGY
- Carcinoid tumors produce serotonin, histamine, bradykinin, and/or prostaglandins
- tumor may also affect the tricuspid and pulmonary valves and cause right heart failure
CLINICAL FEATURES
- diarrhea
- facial flushing
- bronchospasm
- hypotension
- vasodilatory shock
- tricuspid and pulmonary valvular disease (regurgitation, stenosis or both) and right heart failure
INVESTIGATIONS
- 24 hour urinary HIAA (5-hydroxyindoleacetic acid)
- Serum chromogranin-A
- Echocardiography
- Inaging to locate the malignancy (CT, MRI)
MANAGEMENT
- tumor resection
- anti-histamines
- octreotide infusion
- treat vasodilatory shock (e.g. noradrenaline infusion)
- treat right-sided heart failure (e.g., inotropes, diuretics, vasopressors, pulmonary vasodilators)
References and Links
- Fox, D. J. (2004). Carcinoid heart disease: presentation, diagnosis, and management. Heart, 90(10), 1224–1228
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC
