Carcinoid Syndrome Flashcards
Define Carcinoid Syndrome?
Constellation of symptoms caused by systemic release of humoral factors from carcionoid tumours
What is the aetiology of Carcinoid Syndrome?
Carcinoid Syndrome are slow-growing neuroendocrine tumours
They are mostly derived from serotonin-producing enterochromaffin cells
They produce secretory products like serotonin, histamine, tachykinins, kallikrein and prostaglandins
75-80% of patients with carcinoid syndrome have small bowel carcinoids
Why do symptoms sometimes not appear or take time to appear in Carcinoid Syndrome?
Hormones released into the portal circulation will be metabolised by the liver
Symptoms don’t tend to appear until there are hepatic metastases or release into the systemic circulation from bronchial or extrensive retroperitoneal tumours
What is the epidemiology of Carcinoid Syndrome?
RARE
UK incidence: 1/1,000,000
Asymptomatic carcinoid tumours are more common
10% of patients with MEN-1 have carcinoid tumours
What are the presenting symptoms of Carcinoid Syndrome?
Paroxysmal Flushing Diarrhoea Crampy Abdominal Pain Wheeze Sweating Palpitations
What are the signs of Carcinoid Syndrome on physicale examination?
Facial Flushing
Telengiectasia
Wheeze
Right-sided murmurs (tricuspid stenosis/ regurgitation or pulmonary stenosis)
Nodular Hepatomegaly in cases of metastatic disease
Carcinoid Crisis Signs
What are the Carcinoid Crisis Signs?
Profound flushing
Bronchospasm
Tachycardia
Fluctuating BP
What investigations would you do for Carcinoid Syndrome?
24hr Urine Collection Blood CT or MRI scan Radioisotope Scan Investigations for MEN-1
Why do we do 24hrs urine collection for Carcinoid Syndrome?
Check 5-HIAA levels (metabolite of serotonin)
What bloods do we do for Carcinoid Syndrome?
Plasma Chromogranin A and B
Fasting Gut Hormones
Why do we do a CT or MRI scan for Carcinoid Syndrome?
To localise the tumour
Why do we do a Radioisotope Scan for Carcinoid Syndrome?
Radiolabelled somatostatin analogue helps localise the tumour
