Carcinoid Syndrome Flashcards
What is carcinoid syndrome and what are its most
common symptoms?
About 1 in 5 patients with a carcinoid tumor will experience
carcinoid syndrome which results from the massive release of
hormones such as serotonin. The two most common symptoms
are flushing and diarrhea.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 297.
What are the three most common locations for a
carcinoid tumor?
The bronchus, jejuno-ileum, and the colon.
Stoelting RK, Dierdorf SF. Anesthesia & Co-Existing Diseases.
5th ed. New York, NY: Churchill-Livingston; 2008: 289.
What types of substances can be released by a
carcinoid tumor?
arcinoid tumors most notably release serotonin and
prostaglandins, but also release a wide range of peptides
including gastrin, insulin, substance P, glucagon, growth
hormone, and corticotropin.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 297-298.
What diagnostic test is usually indicative of carcinoid
syndrome?
Carcinoid syndrome can be confirmed by detection of urinary 5-
hydroindoleacetic acid.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 743.
Not all patients with a carcinoid tumor experience
side effects from the hormones released from the
tumor. Why not?
Usually, hepatic first-pass metabolism eliminates the hormones
from the circulatory system before they can exert any
deleterious effects.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 798.
Carcinoid syndrome often causes right-sided cardiac
lesions, but typically spares the left-side unless an
intracardiac shunt is present. What accounts for
this?
Elevated serotonin levels can result in right-sided heart failure.
The lungs metabolize serotonin, thus sparing the left side of the
heart. The presence of a right-to-left shunt, however, would
expose the left side of the heart to the serotonin and cause leftsided
heart symptoms.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 297-298.
In which tissues does serotonin act as a vasodilator?
Serotonin acts as a vasoconstrictor in all tissues except the
heart and skeletal muscle, where it acts as a vasodilator. The
renal and pulmonary systems are the most sensitive to the
vasoconstrictive effects of serotonin.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 743.
What are the cardiac manifestations of carcinoid
syndrome?
Cardiac problems associated with carcinoid syndrome are
usually due to fibrosis of the endocardium. Pulmonic stenosis
and tricuspid regurgitation are often present.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 297-298.
How can carcinoid syndrome mimic an allergic
reaction?
Some carcinoid tumors can release histamine and kallikrein
which can result in bronchospasm, tachycardia, and
hypotension.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 297-298.
What medications relieve the diarrhea associated
with carcinoid syndrome?
Serotonin antagonists such 5-HT3 antagonists relieve the
diarrhea in most patients with carcinoid syndrome.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 297-298.
What anesthesia related events should be avoided in
the patient with carcinoid syndrome?
Sympathomimetics such as ephedrine and histamine-releasing
drugs such as morphine, succinylcholine, thiopental, and
atracurium should be avoided if possible as they can trigger the
release of hormones from the tumor as well. Hypotension
should also be avoided in patients with carcinoid tumors as it
can be a trigger for the release of hormones from the tumor.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 798.
