Carcinoid tumours / carcinoid syndrome

Question 1

Carcinoid syndrome usually occurs when

Answer 1

metastases are present in the liver and release serotonin into the systemic circulation

may also occur with lung carcinoid as mediators are not ‘cleared’ by the liver

Question 2

features of carcinoid syndrome ?

Answer 2

flushing (often the earliest symptom)

diarrhoea

bronchospasm

HYPOtension

right heart valvular (tricuspid) stenosis (left heart can be affected in bronchial carcinoid)

pellagra - rarely develop - dietary tryptophan diverted to serotonin by the tumour
lack of nicotinic acid or its precursor tryptophan in the diet - characterized by dermatitis, diarrhoea, and mental disturbance , Scaly skin sores, especially in sun-exposed areas of the skin

Question 3

other molecules such as ACTH and GHRH may also be secreted for example, resulting in ?

Answer 3

Cushing’s syndrome

Question 4

investigation for carcinoid syndrome ?

Answer 4

urinary 5-HIAA
plasma chromogranin A y

Question 5

management of carcinoid syndrome ?

Answer 5

somatostatin analogues e.g. octreotide
diarrhoea: cyproheptadine may help