Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0016382 (flushing)
 6,387 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A review is given on the clinical features of carcinoid syndrome including symptomatology, diagnostics, biochemistry and treatment. We have reviewed the literature on current therapy of carcinoid patients with special emphasis on the use of the somatostatin analogue SMS 20-1995. In addition, we present data on the effects of SMS 201-995 on indices of a clinical, biochemical and tumor growth. Diarrhea is abolished or significantly reduced in 75% of patients, flushing improves in 100%, wheezing in 100% with a decrease in airways resistance, and in one patient myopathy has improved. Blood serotonin is notoriously resistant to intervention and urinary 5-HIAA will decrease in 75% of causes but subsequently rebounds in 38%. Tumors, in general, continue to grow, but this may be slowed or in rare cases tumor growth is arrested. In individual instances the tumor may even infarct, leading to spontaneous cure. Tumors secreting PP, ACTH and calcitonin may be particularly resistant to treatment, whereas VIP secreting tumors appear to be sensitive.
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PMID:Clinical features of carcinoid syndrome and the use of somatostatin analogue in its management. 266 49

Twenty-seven patients with metastatic carcinoid tumor, 24 of whom had the malignant carcinoid syndrome, were treated with recombinant leukocyte A interferon at a planned dose of 24 x 10(6) U/m2. Twenty percent of patients with measurable tumor experienced an objective regression and 39% of those with the carcinoid syndrome experienced a reduction of more than 50% in urine 5-hydroxyindoleacetic acid (5HIAA) excretion. Flushing was partially or completely relieved in 65% of patients and diarrhea was relieved in 33%. Regrettably, these favorable treatment effects were transient in nature, with objective regressions persisting for a median of only 7 weeks and hormonal responses for a median of only 4 weeks. Any therapeutic gain experienced by these patients seemed to be outweighed by the frequency and severity of toxic reactions, which consisted primarily of chills and fever, fatigue, anorexia, weight loss, leukopenia, and abnormalities of liver function. Whereas other interferons, administration by alternative dosages and regimens, or incorporation of interferons into drug combinations may merit future study, we cannot recommend recombinant leukocyte A interferon, administered by the methods we employed, for routine therapy of the carcinoid tumor or syndrome.
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PMID:Therapy of metastatic carcinoid tumor and the malignant carcinoid syndrome with recombinant leukocyte A interferon. 273 23

Nineteen patients with histologically verified midgut carcinoid tumours and liver metastases were included in a prospective study with daily interferon therapy 3 mill IU x m-2 subcutaneously for one year. All had the primary tumour removed at laparotomy, and whenever technically possible, an embolization of the hepatic arteries was performed prior to interferon start. Recombinant human alpha-2b interferon from Schering was employed. When interferon was given alone for one year 40% responded, judged from either a 50% reduction in excretion of 5-hydroxy-indoleacetic acid in the urine or a 50% reduction in the area of the largest liver metastasis, as evaluated by computer tomography. One patient died later on and one withdrew from therapy of her own will; both were responders at the evaluation at 6 months. When prior embolization of the liver arteries had been performed, the response rate was 85% after one year. When diarrhoea and/or flushing was evaluated, 70% had response on interferon alone, while all patients experienced improvement after the combined procedure. We conclude that interferon is an effective treatment of malignant metastatic midgut carcinoid and that embolization of the liver arteries seems to increase the response rate.
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PMID:Recombinant alpha-2 interferon with or without hepatic artery embolization in the treatment of midgut carcinoid tumours. A preliminary report. 274 81

Thirteen patients with ileal carcinoids complicated by liver metastases were treated with human leukocyte interferon (IFN) subcutaneously (s.c.) at doses of 3-6 x 10(6) IU/day 5 days weekly during 12 months. Objective tumour response was obtained in 2 patients, based on reduction in tumour size in one patient and on reduction in tumour markers in the other. Stable disease was noted during the 12-month treatment period in 10 patients. Progressive disease was seen in one patient. This patient exhibited tumour growth, new metastases and increases in tumour markers. Among patients with daily flushing prior to treatment, 50% were free of flush after 12 months of IFN. Adverse effects, including a mild influenza-like syndrome, joint and muscle pains, tiredness and reduction of blood cells were observed but did not necessitate long-term dose reductions. Thus, IFN therapy to midgut carcinoid patients resulted in tumour response or stable disease in 12 out of 13 patients without causing severe side effects.
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PMID:Interferon treatment in patients with malignant carcinoids. 274 82

A 69 year-old male with carcinoid syndrome and undetectable primary tumour, but disseminated liver metastases, was treated with somatostatin analogue octreotide (Sandostatin) and later additionally with recombinant interferon alpha 2 b (r IFN alpha 2 b, Intron A). The carcinoid symptoms (flushing, diarrhoea) were stopped within hours by octreotide. Simultaneously, the urinary 5-hydroxyindolacetic acid (5-HIAA) excretion and serum serotonin levels decreased by more than 50%. In spite of continued treatment with r IFN alpha 2 b a reduction in dosage of octreotide resulted in a rapid recurrence of carcinoid symptoms, suggesting that IFN alpha 2 b had no effect on the carcinoid symptoms in this patient. Since, furthermore, no regression of the tumour mass was observed, treatment with IFN was stopped after 8 months. During 15 months of treatment to date the patient has been kept free of symptoms by octreotide.
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PMID:[Therapy of metastatic carcinoid with the somatostatin analog octreotide and with recombinant interferon alfa 2b]. 276 66

A patient with carcinoid syndrome on long-term antiserotonin therapy with parachlorophenylalanine, experienced a flushing attack with hypotension during the prophylactic administration of aprotonin prior to the induction of anaesthesia. When she was subsequently prepared with a long-acting somatostatin analogue, octreotide (Sandostatin, Sandoz SMS 201-995), plasma levels of tumour-released hormones were reduced and anaesthesia for resection of hepatic metastases was uneventful. The advantages of an anaesthetic approach based on inhibition of carcinoid tumour activity, rather than antagonism of released hormones, are discussed.
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PMID:Somatostatin, anaesthesia, and the carcinoid syndrome. Peri-operative administration of a somatostatin analogue to suppress carcinoid tumour activity. 288 27

Carcinoid syndrome produces flushing, bronchoconstriction and gastrointestinal hypermotility secondary to serotonin, histamine, bradykinin and prostaglandin release. A variety of drugs, foods and anaesthetic agents may provoke this syndrome. Under anaesthesia, the flushing produced may be associated with acute hypotension and cardiovascular collapse; this phenomenon is called a carcinoid crisis. Recently, somatostatin analogue has been used successfully to treat intraoperative carcinoid crisis. In this report, we present a 66-year-old lady with carcinoid syndrome who was pre-treated with 50 micrograms somatostatin analogue IV and IM prior to surgical manipulation. The anaesthetic course was relatively uneventful and the patient did well postoperatively.
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PMID:Pre-treatment with somatostatin in the anaesthetic management of a patient with carcinoid syndrome. 290 85

Carcinoid tumors are the most frequent gut neuroendocrine tumors accounting for more than 50% of all tumors of the gastroenteropancreatic (GEP) axis. These tumors appear to derive from a stem cell line capable of differentiating into a variety of malignant cells that secrete many different peptides and amines. The symptoms of carcinoid tumors are often non-specific, vague abdominal pain that may precede the diagnosis by a median of 9 years. Carcinoid syndrome occurs in less than 10% of patients. We evaluated the effects of SMS 201-995 in 14 such patients, 12 with diarrhea, 8 with flushing, 3 with wheezing, one with tricuspid valve incompetence, 6 with facial telangiectasia, 3 with a pellagra type dermatosis and one with myopathy. Diarrhea was abolished or significantly reduced in 83%, flushing in 100%, wheezing in 100%, and myopathy improved in the one patient. Blood serotonin was resistant to change, urine 5HIAA fell in 75%, and most gut neuropeptide hormones apart from somatostatin were suppressed. Tumor growth appeared to be slowed in 2/3 of cases treated for up to 4 years. The analog of somatostatin appears to be a useful addition to the therapeutic armamentarium for carcinoid tumors and the symptom complex.
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PMID:Use of somatostatin analog in management of carcinoid syndrome. 292 Jun 54

The exact etiology of carcinoid flushing remains unknown, but the symptoms are probably mediated through release of one or several humoral substances. Flushing seen in fore-gut carcinoids (gastric carcinoids) has been ascribed to excessive histamine release, whereas flushing seen in mid-gut carcinoids (ileal carcinoids) tentatively has been ascribed to excessive release of serotonin, bradykinin, substance P, substance K or eledoisin. In this study plasma histamine was measured in 8 patients with mid-gut carcinoids and carcinoid syndrome using an enzymatic isotopic method in order to evaluate histamine as the vasoactive agent in patients with ileal carcinoid tumours and carcinoid syndrome. All patients had raised plasma histamine values. In patients with mid-gut carcinoids histamine may be one of the substances mediating flushing.
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PMID:Histamine in carcinoid syndrome. 318 38

Facial flushing is usually not associated with hypoglycemia. Diabetics treated with chlorpropamide can have an antabuse-like flushing with ingestion of alcohol, but flushing secondary to hypoglycemia per se has not been reported. The first case demonstrating that facial flushing can occur in insulin-induced hypoglycemia is described. This patient had marked erythematous facial flushing that was repeatable with each instance of hypoglycemia. Endocrine evaluation revealed no evidence of carcinoid or a pheochromocytoma in this patient and the facial flushing was unrelated to alcohol. Without insulin-induced hypoglycemia, this diabetic patient has had no further facial flushing in one year follow-up.
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PMID:Facial flushing secondary to hypoglycemia. 332 91


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