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Carcinoid Syndrome

by Carlo Raj, MD
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    00:01 Our topic brings us to Carcinoid Syndrome.

    00:03 Here, once again, I wanna make sure that I clarify any doubt that you might have about carcinoid tumor syndrome or bronchiocarcinoid.

    00:12 Let?s begin. Tumors arising from entero-chromaffin like cell.

    00:17 Stop there. Entero-chromaffin. That?s sounds rather endocrine in nature and that?s exactly right.

    00:24 Therefore, anytime you find anything with carcinoid, please understand that you?re going to produce all these interesting peptides and I say interesting because there are approximately 40 of them.

    00:35 Of all the 40 or so, you?ll be paying attention to serotonin.

    00:41 The syndrome of watery diarrhea, flushing, bronchospasm, right heart failure, that?s a syndrome of versus tumor. So what happened? And that grows, aren't you seeing the same thing? No.

    00:57 Carcinoid tumor will be located in the intestine. It does not metastasize.

    01:01 My golly though, it is going to produce all these various peptides including serotonin.

    01:08 So you really, you don?t have any clinical manifestation of carcinoid tumor because these chemicals enter the portal vein, enter the liver, because the liver is not damaged and there?s no metastasis, the liver can handle everything that?s coming from the intestine.

    01:25 So there is no flushing, no right-sided valvular heart disease and definitely no bronchospasms.

    01:34 Carcinoid syndrome quite different. So what happens in carcinoid syndrome? It?s a fact that you have an entero-chromaffin tumor that has now metastasized from the intestine has now colonized the liver, behaves exactly like a carcinoid tumor but now you?re in the liver.

    01:55 Now you have to call this syndrome, all these chemicals, peptides will exit the liver because the liver will not have a chance to neutralize and detoxify and maybe a few but not much. Will enter the hepatic vein inferior vena cava.

    02:10 Where are you gonna enter? Right side. So you are going up right-sided.

    02:16 Just keep in mind valvular diseases. Maybe some tricuspid regurgitation, may be some pulmonic stenosis. You?re then going to move the chemicals, will then move into the bronchi or respiratory system.

    02:29 You are going to have bronchospasms, which you must find with carcinoid syndrome.

    02:38 Take a look at the skin and it will be flushed, okay? Flushed, vasodilation, bronchoconstriction.

    02:47 Doesn?t this sound off a lot like histamine? But serotonin is not doing that, okay but there are a bunch of peptides in there.

    02:55 Welcome to carcinoid syndrome.

    02:57 The tumor causes conversion of dietary tryptophan to serotonin, histamine and bradykinin, there you go.

    03:04 That will give you your flushing. The tumor were metastasis.

    03:09 The symptoms suggest meets to liver or primarily outside the gut due to high first pass effect. Is that clear? So, now at this point you have metastasis that has then moved over to the liver and from here off you go into the system, unfortunately.

    03:26 This is carcinoid syndrome. You pay attention to this, carcinoid tumor, symptoms unlikely.

    03:34 In your stool, diagnosis: This is a secretory type of diarrhea.

    03:39 You would expect to find serotonin metabolite known as 5-hydroxyindoleaceticacid, the acronym: 5-HIAA.

    03:49 In addition, carcinoid syndrome.

    03:54 Management: Octreotide and surgery.

    03:57 Octreotide is seen in different places, haven?t we? Including your acromegaly and company.


    About the Lecture

    The lecture Carcinoid Syndrome by Carlo Raj, MD is from the course Small and Large Intestine Diseases.


    Included Quiz Questions

    1. Enterochromaffin cells
    2. PP cells
    3. Schwann cells
    4. Beta cells of islets of pancreas
    5. Ganglion cells
    1. 5-HIAA
    2. Insulin
    3. Glucagon
    4. Epinephrine
    5. Inhibin
    1. Tryptophan
    2. Tyrosine
    3. Threonine
    4. Methionine
    5. Lysine
    1. Carcinoid syndrome is only seen in the gastrointestinal tract.
    2. The active metabolites produced by carcinoid tumor is detoxified in the liver preventing the manifestation of symptoms.
    3. Carcinoid syndrome can produce flushing and watery diarrhea.
    4. Urinary levels of 5-HIAA is high in carcinoid syndrome.
    5. Symptoms suggests to metastasis to the liver from carcinoid tumor.

    Author of lecture Carcinoid Syndrome

     Carlo Raj, MD

    Carlo Raj, MD


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