They primarily secrete serotonin (5HT) but may also produce histamine/adrenal hormones/insulin...
45% of carcinoid tumours are in the appendix and a further 30% in the ileum.
They can cause complications such as appendicitis, obstruction or intussception.
Having said carcinoid tumours are common, it's important to understand that carcinoid syndrome is rare - it only occurs when the liver is involved, as tumours in other places will have their 5HT metabolised rather than it have an effect.
Features of carcinoid syndrome are:
- flushing
- diarrhoea
- bronchospasm
- pellegra
- hypotension
Diagnosis is by:
- urinary 5-HIAA
- plasma chromograffin - the new way which, depending on the leve, also gives an indication of the mass of tumours
Treatment is:
- surgery
- ocreotide
Survival from diagnosis tends to be 5 to 8 years.
Patients with carcinoid heart disease have a worse prognosis.
It is also worth remembering that if these tumours are over-handed (eg during surgery) or out-grow their blood supply, a massive 'hormone hit' can be released in one go, causing a carcinoid crisis.
Features of a carcinoid crisis:
- vasodilation
- hypotension
- tachycardia
- bronchoconstriction
- hyperglycaemia
So those are today's battles fought, and hopefully won. Click here if you want to partake of the 'war' of questions to check your recall of yesterday's topics.
