Anesthesia and Carcinoid Syndrome
- enterochromaffin tumors
- secrete vasoactive substances
- serotonin
- kallikrein
- histamine
- most located in the gastrointestinal tract
- vasoactive substances secreted into portal circulation, so
- most are destroyed by the liver
- nonintestinal tumors
- pulmonary
- ovarian
- hepatic metastases
- secretions bypass liver and cause systemic manifestations
Clinical Manifestations
- sertonin
- vasoconstriction
- coronary artery spasm
- hypertension
- increased intestinal tone
- water and electrolyte imbalance (diarrhea)
- tryptophan deficiency (hypoproteinemia, pellagra)
- vasoconstriction
- kallikrein
- vasodilation
- hypotension
- cutaneous flushing
- bronchoconstriction
- vasodilation
- histamine
- vasodilation
- hypotension
- cutaneous flushing
- dysrhythmias
- bronchoconstriction
- vasodilation
- right-sided heart disease
- due to valvular and myocardial plaque formation
- lung metabolism protects left heart
- diagnosis
- suggested by elevated plasma chromogranin A
- confirmed by elevated urinary serotonin metabolites
- 5-hydroxyindoleacetic acid
- treatment
- depends on tumor location
- surgical resection
- serotonin and histamine antagonists
- somatostatin
- inhibitory peptide
- reduces release of vasoactive tumor products
Anesthetic Considerations
- minimize release of vasoactive substances from tumor
- treat hypotension with volume expansion
- beware: catacholamine administration may activate kallikrein
- regional anesthesia may limit perioperative stress
- avoid histamine-releasing drugs (e.g. morphine, atracurium)
- beware: surgical manipulation of tumor
- monitors
- arterial line
- CVP line
- consider pulmonary artery catheter
- monitor blood glucose
- consult endocrinologist to clarify role of
- antihistamines
- antiserotonin drugs
- methysergide
- octreotide (long-acting somatostatin analog)
- antikallikrein drugs (e.g. corticosteroids)
