42. Carcinoid syndrome Flashcards Preview

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Flashcards in 42. Carcinoid syndrome Deck (27):
1

Carcinioid syndrome - frequency

rare syndrome

2

carcinoid syndrome is caused by

carcinoid tumors, especially metastatic small bowel tumors, which secrete high levels of seretonin (5-HT)

3

tumor histology

1. NEuroendocrine cells
2. Prominent rosettes
3. positive chromogranin

4

most coomon tumor

metastatic bowel tumors

5

tumor to Gi tract

Carcinoid syndrome is not seen if the tumor is limited to GI tract because seretonin undergoes first - pass metabolism in liver

6

Carcinoid syndrome - treatment

1. surgical resections
2. somatostatin analog ( eg . octeotide)

7

Carcinoid syndrome - symptms

1. recurrent diarrhea
2. cutaneous flushing
3. asthamatic wheezing
4. right-sided valvular disease ( tricuspid regurgitation, pulmonary stenosis

8

carcinoid syndrome rarely can cause ( why)

pellagra
niacin deficiency ( increased ttryptophan metabolism

9

Carcinoid syndrome - labs

1. increased 5-hydroxyindoleacetic ( 5-HIAA) in urine
2. niacin deficiency

10

5-HIAA

5-hydroxyindoleacetic

11

symtops of pellagra

1. Diarrhea
2. Dementia
3. Dermatitis

12

symptoms of carcinoid syndrome can be triggered by ( why )

1. alcohol
2. emotional stress
stimulate seretonin release from the tumor

13

carcinoid syndrome effects on heart ( and mechanisms)

1. triscuspid regurgitation
2. pulmonary valve stenosis
INCREASED COLLAGEN

14

Carcinoid syndrome - rule of 1/3

1/3 metastasize
1/3 present seconday malignancy
1/3 multiple

15

mc malignancy of small intestine

carcinoid tumor

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endocrine tumor with DVT

glucagonoma

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Somatostatinoma is tumor of ..... ---> overproduction of --->

δ pancreatic cells
- somatostatin ---> decreases secretion of cholecystokinin, glucagon , insulin, gastrin

18

somatostainoma may present with

1. diabetes/ glucose introlerance
2. steatorrhea
3. gallstones

19

somatostatinoma - tx

surgical resection
somatostatin analogs ( eg. octeotide) for symptom control

20

insulinoma - epidemiology

10% are associated with MEN 1 syndrome

21

• A patient experiences diarrhea, flushing, and asthmatic wheezing, and you suspect carcinoid syndrome. What might the cardiac workup reveal?

Tricuspid regurgitation or pulmonic stenosis due to right-sided valvular disease

22

• Carcinoid tumor is the most common malignancy in the ____.

Small intestine

23

• A man with a small bowel tumor experiences labored breathing, diarrhea, and a flushed face. What serum and urinary finding do you expect?

Niacin deficiency and elevated urine 5-hydroxyindoleacetic acid (5-HIAA)

24

• A man with a small bowel tumor has labored breathing, diarrhea, and a flushed face. Treatment?

Carcinoid syndrome (from the carcinoid tumor) is treated with resection and/or somatostatin analogs (e.g., octreotide)

25

• A patient with carcinoid tumor asks you about the likelihood of metastases. How do you respond?

There is a 33% chance (rule of 1/3's = 1/3 metastasize, 1/3 present with second malignancy, 1/3 are multiple)

26

• A patient has diarrhea, flushing, wheezing, pellagra, and increased 5-HIAA in his urine. What causes this syndrome?

Neuroendocrine tumors (especially metastatic small bowel tumors) that secrete high levels of serotonin (carcinoid syndrome)

27

• A man with a tumor thought to be limited to the gastrointestinal tract suddenly experiences wheezing, flushing, and diarrhea. Why?

Hepatic metastases (when GI tract–limited tumors secrete 5-HT, it is metabolized in the liver and 5-HT can enter the system after metastasis)