medical slideshow

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Carcinoid syndrome
DR. HIWA OMER AHMED
PROFESSOR IN GENERAL AND BARIATRIC SURGERY
UNIVERSITY OF SULAIMANI
COLLEGE OF MEDICINE – SULAIMANI CITY- KURDISTAN

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CARCINOID SYNDROME
 A carcinoid tumor appears after metastasis of the tumor to the
lungs or liver.
1. Flushing (pale, purplish, or red)
2. Diarrhea (watery and explosive)
3. Tachycardia
4. Hypotension
5. Bronchospasm
6. Telangiectasia
7. Rght-sided heart disease or failure.1,

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Precipitating foods
Symptoms often are precipitated by exertion or by eating or
drinking (especially items high in tyramine
 Blue cheeses
 Chocolate]
 Ethanol [e.g., red wine]).

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Active substances
 Carcinoid tumors contain many neurosecretory granules that are capable
of the synthesis, storage, and release of substances, including
 Serotonin
 Histamine
 Prostaglandins
 Kallikrein, bradykinins
 Substance P
 Gastrin
 Corticotrophin,
 Neuron-specific enolase.

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 The most prominent of these substances is serotonin (i.e., 5-
hydroxytryptamine).
 Degradation of 5-hydroxytryptamine results in 5-hydroxyindoleacetic acid
(5-HIAA), which is excreted in the urine.
 When released in the systemic circulation, 5-hydroxytryptamine can result
in the symptoms of carcinoid syndrome
 Like the excitation of smooth muscle leads to
1. Increased gastrointestinal motility
2. Bronchoconstriction
3. Platelet aggregation
4. Vascular constriction and dilatation.1

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On metastasis
 The lungs and liver metabolize many of the
substances secreted by carcinoid tumors, thus
preventing their release into the systemic circulation
until metastases develop.
 The syndrome is variable: patients may not have all
symptoms, and the symptoms may vary in intensity
and timing.
 Carcinoid syndrome occurs in only 10 percent of all
patients with carcinoid tumors, and it is most often
associated with midgut tumors.

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Differential Diagnosis of Carcinoid
Syndrome
1. Flushing
Menopausal syndrome; pheochromocytoma; mastocytosis; benign cutaneous
flushing; medullary carcinomas of the thyroid; ingestants (e.g., food, drugs)
2. Wheezing
Asthma; anaphylaxis; pulmonary edema; bronchial foreign body
3. Diarrhea
Gastroenteritis; inflammatory bowel disease; infectious colitis; laxative abuse
4. Heart valve symptoms ( mostly right side, as serotonin metabolized in lung)
Rheumatic heart disease; subacute bacterial endocarditis; dilated cardiomyopathy;
ischemic heart disease with papillary muscle dysfunction

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Diagnosis
 For patients with vasoactive symptoms
1. measuring the urinary excretion of 5-HIAA
2. serum chromogranin A level
 For those with symptoms of bowel dysmotility syndromes
1. Computed tomography (CT)
2. M resonance imaging (MRI) may be helpful and often will note the
coincidental presence of hepatic metastases that may be the first clue as
to the presence of the primary tumor.

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Treatment
 Systematic treatment options:
 5-HT3-receptor antagonist (ondasetrone)
 Long-acting somatostatin analogues
 Interferon
 Hepatic artery embolization
 Hepatic artery ligation with or without interferon, with or without
chemotherapyDiarrhea
 Heart disease: diuretics, long-acting somatostatin analogues, occasional valvular
replacemen
 Flushing; avoid precipitating food and alcohol
 GIT symptomes antidiarrheal agents
 Wheezing, selective bronchodilators;