Carcinoid Crisis
Definition:
-Carcinoid crisis is the most serious and life-threatening complication of carcinoid syndrome and is generally found in people who already have carcinoid syndrome.
-Carcinoid crisis occurs when all of the symptoms of carcinoid syndrome come at the same time.
Causes:
➧ Spontaneous
➧ Precipitating factors:
-Stress, Sympathetic stimulation
-Hypotension
-Histamine-releasing drugs
-Tumour manipulation
-Regional anesthesia due to hypotension
-Infection
-Chemotherapy
Clinical picture:
-Tachycardia, Arrhythmia
-Hypotension, Shock
-Flushing, Hyperthermia
-Bronchospasm
-Abdominal pain, Diarrhea
Management:
Inhibit growth h. & vasoactive peptides release:
-Somatostatin analogs (Octreotide, Lanreotide)
Anti-serotonin:
-Methesergide, Ketanserin, Cyproheptadine, Ondansetron, Alpha-methyl dopa
Anti-kallikrein:
-Corticosteroids, Aprotinin
Anti-histamine:
-H1 blockers (Diphenhydramine) & H2 blockers (Ranitidine)
R of Bronchospasm:
-Salbutamol, Aminophylline
R of Diarrhea:
-Loperamide
R of Hypotension:
-Vasopressin, Phenylephrine
R of Hypertension:
-Alpha-blockers, Beta-blockers
R of Rt. Heart failure:
-Digitalis, Diuretics
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