A prospective study of the pathophysiology of carcinoid crisis

Condron, Mary; Jameson, Nora E.; Limbach, Kristen E.; Bingham, A.; Sera, Valerie; Anderson, R. B.; Schenning, Katie J.; Yockelson, Shaun; Harukuni, Izumi; Kahl, Edward A.; Dewey, Elizabeth; Pommier, SuEllen J.; Pommier, Rodney F.

doi:10.1016/j.surg.2018.04.093

Cited by 47 publications

(54 citation statements)

References 25 publications

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“…A carcinoid crisis is a potentially life-threatening complication of carcinoid syndrome caused by the sudden release of 5-HT and other vasoactive peptides, such as histamine, kallikreins, or catecholamines, which are precipitated by tumor manipulation during surgery, percutaneous needle biopsy, or even anesthesia [1,16]. It manifests as hypotension or hypertension, diarrhea, bronchoconstriction, flushing, and acidosis [17].…”

Section: Pathophysiologymentioning

confidence: 99%

Carcinoid Syndrome: A Review

Gade¹,

Olariu²,

Douthit³

2020

Cureus

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Carcinoid syndrome (CS) is a paraneoplastic syndrome caused by the release of serotonin and other substances from well-differentiated neuroendocrine tumors (NETs). The hallmark symptoms of carcinoid syndrome are flushing and diarrhea; atypical signs and symptoms can include wheezing, abdominal pain, valvular heart disease, telangiectasias, pellagra, and the complications of mesenteric fibrosis, including ureteral obstruction, bowel obstruction, and bowel ischemia. These symptoms are mediated by the release of serotonin (5-HT), histamine, kallikrein, prostaglandins, and tachykinins. The diagnosis of CS requires these symptoms and corresponding elevations in lab tests. Treatment options include surgery and medical management with somatostatin analogs.

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Section: Pathophysiologymentioning

confidence: 99%

Carcinoid Syndrome: A Review

Gade¹,

Olariu²,

Douthit³

2020

Cureus

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“…Rather, it is mostly suggestive of distributive shock due to observed intracardiac hypovolemia and decreased systemic vascular resistance. 34 Octreotide, a somatostatin analog (SSA), has been used in both prophylactic and therapeutic capacities for carcinoid crisis. Patients are treated with long-acting octreotide prior to procedural intervention.…”

Section: Carcinoid Crisismentioning

confidence: 99%

“…36 Currently, periprocedural octreotide is recommended because carcinoid crisis is suspected to occur secondary to massive hormone release, even if the active substance is not specifically identified, but it should be paired with fluid resuscitation and vasopressors for resuscitation during carcinoid crisis to decrease postoperative complications. [34][35][36][37][38]…”

Section: Carcinoid Crisismentioning

confidence: 99%

Management of Gastrointestinal Neuroendocrine Tumors

Wang

Zheng-Pywell

Chen

et al. 2019

Clin Med Insights Endocrinol Diabetes

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Neuroendocrine neoplasms (NENs) are derived from neuroendocrine cell system and can have benign or malignant characteristics. They are rare tumors, but have been increasing in incidence over the past 40 years. Patients with NENs may develop symptoms due to primary tumor invasion, metastasis, or from secretion of hormonally active tumor substances. Multiple imaging modalities are used for diagnosis and staging, including specialty scans such as 111In pentetreotide (Octreoscan) and 68Gallium-DOTATATE, along with endoscopy, endoscopic ultrasound, and biochemical marker testing. Treatment involves both surgical approach, for both primary and metastatic lesions, as well as medical management for symptom management and disease progression. This article will review the current clinical knowledge regarding the diagnosis, treatment, and prognosis of these fascinating neoplasms and the associated hormonal syndromes.

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“…e current hypothesis is that a rapid release of vasoactive hormones by NEN cells will cause a crisis. A recent study on 46 patients with carcinoid syndrome having abdominal surgery could not confirm this hypothesis: no massive release or changes in serotonin, histamine, kallikrein, or bradykinin were observed in patients having a hypotensive episode during surgery [107]. Carcinoid crisis appears spontaneously but can be precipitated by surgery, anaesthesia, chemotherapy, PRRT, radiological procedures, and stress.…”

Section: Complications: Carcinoid Crisismentioning

confidence: 95%

Update on Pathophysiology, Treatment, and Complications of Carcinoid Syndrome

Clement

Ramage

Srirajaskanthan

2020

Journal of Oncology

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Carcinoid syndrome (CS) develops in patients with hormone-producing neuroendocrine neoplasms (NENs) when hormones reach a significant level in the systemic circulation. The classical symptoms of carcinoid syndrome are flushing, diarrhoea, abdominal pain, and wheezing. Neuroendocrine neoplasms can produce multiple hormones: 5-hydroxytryptamine (serotonin) is the most well-known one, but histamine, catecholamines, and brady/tachykinins are also released. Serotonin overproduction can lead to symptoms and also stimulates fibrosis formation which can result in development of carcinoid syndrome-associated complications such as carcinoid heart disease (CaHD) and mesenteric fibrosis. Transforming growth factor beta (TGF-β) is one of the main factors in developing fibrosis, but platelet-derived growth factor (PDGF), basic fibroblast growth factor (FGF2), and connective tissue growth factor (CTGF or CCN2) are also related to fibrosis development. Treatment of CS focuses on reducing serotonin levels with somatostatin analogues (SSA’s). Telotristat ethyl and peptide receptor radionuclide therapy (PRRT) have recently become available for patients with symptoms despite being established on SSA’s. Screening for CaHD is advised, and early intervention prolongs survival. Mesenteric fibrosis is often present and associated with poorer survival, but the role for prophylactic surgery of this is unclear. Depression, anxiety, and cognitive impairment are frequently present symptoms in patients with CS but not always part of their care plan. The role of antidepressants, mainly SSRIs, is debatable, but recent retrospective studies show evidence for safe use in patients with CS. Carcinoid crisis is a life-threatening complication of CS which can appear spontaneously but mostly described during surgery, anaesthesia, chemotherapy, PRRT, and radiological procedures and may be prevented by octreotide administration.

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A prospective study of the pathophysiology of carcinoid crisis

Cited by 47 publications

References 25 publications

Carcinoid Syndrome: A Review

Carcinoid Syndrome: A Review

Management of Gastrointestinal Neuroendocrine Tumors

Update on Pathophysiology, Treatment, and Complications of Carcinoid Syndrome

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