Carcinoid Crisis

 

Mechanism: sudden release of large amounts of serotinin or other vasoactive peptides from the carcinoid tumor

 

The crisis may be triggered by:

(1) surgery

(2) embolization of a tumor

(3) fine needle aspirate or needle biopsy

(4) tumor manipulation such as palpations during physical examinations

(5) transesophageal echocardiography

(6) nothing at all (spontaneous)

 

Clinical features:

(1) profound flushing

(2) marked change in blood pressure (usually hypotension, less often hypertension)

(3) shock

(4) watery diarrhea

(5) bronchoconstriction

(6) acidosis

 

Complications:

(1) acute renal failure

(2) coronary artery spasm with myocardial infarction

 

Management may include:

(1) infusion of octreotide (which can be given prophylactically)

(2) therapy with cyproheptadine and corticosteroids