Carcinoid syndrome

147 Carcinoid syndrome



Instruction


Look at this patient who was told by her GP that she has a ‘nervous bowel’.



Salient features



History




• Confirm a history of chronic intermittent diarrhoea


• Flushing attacks, which may be associated with increased lacrimation and periorbital oedema. Flushing may be provoked by eating, exertion, excitement or ethanol


• Wheeze (caused by bronchoconstriction during flushing attacks).



Examination




• Flushed face (‘fire-engine’ face)


• Telangiectasia.


Proceed as follows:



• Listen to the chest for wheeze (bronchial carcinoid)


• Listen to the heart (right-sided murmurs in intestinal, gastric, hepatic and ovarian carcinoid, left-sided murmurs in bronchial carcinoid)


• Look for hepatomegaly (nodular and firm from metastases, may be pulsatile from tricuspid regurgitation).



Diagnosis


This patient has facial flushing and tricuspid regurgitation (lesion) caused by carcinoid syndrome (aetiology) and is in cardiac failure (functional status).


Remember



• Carcinoid tumours, now referred to as neuroendocrine tumours (NETs). NETs include a wide spectrum of neoplasms and clinical behaviours depending on their site of origin, hormonal production, and differentiation.


• Be prepared to discuss carcinoid biochemical pathways.

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Carcinoid syndrome

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