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REGARDING FEATURES OF CARCINOID SYNDROME---

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REGARDING FEATURES OF CARCINOID SYNDROME---

Post by nomoredoc on Tue Nov 27, 2007 10:29 pm

Question all of the following are recognized except-----
1)flushing
2)bronchospasm
3)skin changes of pellagra
4)increased urinary excretion of VMA

confused [DOUBT IS BETWEEN (3) & (4)!!!]
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Re: REGARDING FEATURES OF CARCINOID SYNDROME---

Post by drbond on Tue Nov 27, 2007 10:39 pm

ans is 4 bcoz its HIAA which is increased in urine
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Re: REGARDING FEATURES OF CARCINOID SYNDROME---

Post by sonia on Wed Nov 28, 2007 4:45 am

answer is definitely 4 since urinary values of 5-hiaa r measured to diagnose carcinoids and the normal levels r between 2 to 8 mg per day and in carcinoid these r increased,symptoms of diarrhoea and flushing mainly seenupto 73 percent and mc and histamine release by carcinoid is responsible for it.symptoms of pellagra r seen in 2 percent people,this is becos the main secretory product is serotonin wich is derived frm tryptophan of dietso less of trytophan for conversion to niacin as a result pellagra occursother symptoms seen r asthma like and wheezing and also fibrosis of non cardiac structures like retroperitoneal fibrosis,peyeronies disease of penis and occlusion of mesentric veins .reference harrison page 2224 and 2225,16 edition
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Re: REGARDING FEATURES OF CARCINOID SYNDROME---

Post by behappy on Fri Nov 30, 2007 4:32 pm

Findings/presentation of carcinoid syndrome :

Cutaneous flushing (75% to 90%)
1. The patient usually has red-purple flushes starting in the face, then spreading to the neck and upper trunk.
2. The flushing episodes last from a few minutes to hours (longer-lasting flushes may be associated with bronchial carcinoids).
3. Flushing may be triggered by emotion, alcohol, or foods, or it may occur spontaneously.
4. Dizziness, tachycardia, and hypotension may be associated with the cutaneous flushing.

Diarrhea (>70%): often associated with abdominal bloating and audible peristaltic rushes
Intermittent bronchospasm (25%): characterized by severe dyspnea and wheezing
Facial telangiectasia
Tricuspid regurgitation from carcinoid heart lesions

LABORATORY TESTS

The biochemical marker for carcinoid syndrome is increased 24-hr urinary 5-hydroxyindoleacetic acid (5-HIAA), a metabolite of serotonin (5-hydroxytryptamine).
False elevations can be seen with ingestion of certain foods (bananas, pineapples, eggplant, avocados, walnuts) and certain medications (acetaminophen, caffeine, guaifenesin, reserpine); therefore patients should be on a restricted diet and should avoid these medications when the test is ordered.
Liver function studies are an unreliable indicator of liver involvement.

Treatment :

Control of clinical manifestations:
1. Diarrhea usually responds to diphenoxylate with atropine (Lomotil).
2. Flushing can be controlled by the combination of H1- and H2-receptor antagonists (e.g., diphenhydramine 25 to 50 mg PO q6h and ranitidine 150 mg bid).
3. Somatostatin analogue (SMS 201-995) is effective for both flushing and diarrhea in most patients.
4. Bronchospasm can be treated with aminophylline and/or albuterol.

Nutritional support: supplemental niacin therapy may be useful to prevent pellagra, because the tumor uses dietary tryptophan for serotonin synthesis, resulting in a nutritional deficiency in some patients


Surgical resection of the tumor can be curative if the tumor is localized or palliative and results in prolonged asymptomatic periods if metastases are present. Surgical manipulation of the tumor can, however, cause severe vasomotor abnormalities and bronchospasm (carcinoid crisis).

I also agree with option 4
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Re: REGARDING FEATURES OF CARCINOID SYNDROME---

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