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)

Although patients with bronchial and ovarian carcinoid tumors can develop the carcinoid syndrome (diarrhea and/or flushing) in the absence of hepatic metastasis, it is believed that development of the carcinoid syndrome in patients with carcinoid tumors of gastrointestinal origin occurs only after the patient has hepatic metastasis. This is explained by hepatic inactivation of most of the serotonin in the portal circulation or by the fact that hepatic metastases are larger than the primary tumor in the gastrointestinal tract. Three patients with ileal and jejunal carcinoid tumors who developed the carcinoid syndrome without obvious hepatic metastasis are described. Two of the patients had intra-abdominal, but extrahepatic, metastasis that probably drained directly into the systemic circulation. The third patient had an ileal carcinoid with clinical involvement limited to adjacent mesenteric lymph nodes. Following resection of her tumor, her urinary 5-HIAA excretion and platelet serotonin level returned to normal, and her attacks of carcinoid flushing virtually ceased. She has occasional spells of "blushing" that are thought to be benign; however, further close follow-up study will be needed to be certain that she is free of disease. It is suggested that each patient with the carcinoid syndrome be evaluated with CT and technetium-99 pertechnetate liver scans. If there is no liver involvement detected with these studies, one should consider hepatic arteriogram or laparotomy to determine if the patient's tumor might be totally resectable.
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PMID:Carcinoid syndrome from gastrointestinal carcinoids without liver metastasis. 709 50

We report a case of carcinoid-like syndrome in a patient with metastatic renal cell carcinoma. Peripheral venous plasma levels of prostaglandin (PG) E and of a derivative of PGF2 alpha were raised during the attacks. The urinary excretion of 5-hydroxyindoleacetic acid was repeatedly normal. The flushing attacks were not prevented by therapy with antihistamines, phenothiazines, antiserotonin agents, or glucocorticoids. Treatment with aspirin completely prevented the attacks, and its withdrawal led invariably to their recurrence.
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PMID:A carcinoid-like syndrome caused by a prostaglandin-secreting renal cell carcinoma. 739 16

Over a five-and-a-half-year period, there were 298 laboratory requests for urinary 5-hydroxyindoleacetic acid (5-HIAA). The clinical and laboratory associations of the 24 patients in which there were 43 urinary 5-HIAA 24-h collection results greater than the laboratory upper reference limit are detailed. Four were confirmed carcinoid tumours and two were phaeochromocytomas. Flushing was a prominent symptom in 46% and diarrhoea or altered bowel habit in 37%. Associated with the raised urinary 5-HIAA values were increased levels of 4-hydroxy-3-methoxymandelic acid and homovanillic acid in 14.3% and 21%, respectively, of those collections where the metabolites were requested. Diagnostic imaging was performed in 57%. While the specificity was 88%, 5-HIAA is relatively insensitive in the diagnosis of carcinoid tumours and a more widespread use of diagnostic imaging including isotope scanning with labelled metaiodo-benzylguanidine, vasoactive intestinal peptide and octreotide is suggested.
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PMID:The clinical and laboratory correlates of an increased urinary 5-hydroxyindoleacetic acid. 747 66

Octreotide acetate, a long-acting somatostatin analogue, is effective in controlling and markedly reducing the symptoms of carcinoid crisis. We report a patient with carcinoid syndrome with prolonged survival for 4.5 years with high dose octreotide therapy and survived for 7.5 years after the first flushing, in spite of episodes of severe carcinoid crisis. Dose escalation was required in order to control carcinoid symptoms, and the final dosage was 5,950 micrograms/day. Although administration of such a high dosage of octreotide has never been reported before, we found that octreotide could be used at this dosage safely without inducing serious side effects, and probably prolonged the patient's survival. Our experience with this case indicates that octreotide acetate is an effective drug in controlling carcinoid crisis and prolonging survival without serious side effects.
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PMID:Long-term survival in a patient with malignant carcinoid treated with high-dose octreotide. 751 29

The carcinoid syndrome is a rare clinical entity mainly characterized by flushing and diarrhoea. It is due to different biological mediators produced by tumours that arise from enterochromaffin cells. Such tumours are typically located in the ileum, have a long course and become symptomatic only in the presence of overt liver metastases. Among the involved mediators, the role of serotonin (5-hydroxytryptamine, 5-HT) has been ascertained in the pathogenesis of diarrhoea, while it remains controversial in that of flushing. Ketanserin is a 5HT-2 antagonist with no mixed receptor agonist-antagonist activity. We report the case of a severely distressing carcinoid syndrome fully dominated by ketanserin. The patient was a 75-year-old man, who came to our attention because of marked weight loss, impossibility to feed and almost continuous diarrhoea due to liver colonization of a mid ileum carcinoid tumour, previously resected at the age of 65. Sustained facial and trunk flushing also presented several times daily. Ketanserin, 20 mg twice a day orally, was administered and then increased up to 40 mg daily with no side effects and progressive complete control of both diarrhoea and flushing. It is suggested that ketanserin, due to its availability and tolerability, should first be considered for palliative relief of carcinoid syndrome. The literature on this subject is extensively reviewed.
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PMID:[Symptomatic relief of carcinoid syndrome by ketanserin. A case]. 763 30

The prognosis and the quality of life of patients with carcinoid tumors is related either to symptoms from the substances secreted or to progressive tumor growth. Medical treatment with cytotoxic agents is of marginal value for increasing life expectancy and reducing clinical symptoms. Recent studies with interferon have shown interesting results. In the present investigation, 22 patients with carcinoid tumors and syndrome were treated with recombinant interferon alpha-2a (r-IFN alpha-2a) at the dose of 6 x 10(6) IU intramuscularly daily for 8 weeks and three times weekly thereafter. The primary tumor was localized in the foregut (n = 11), midgut (n = 7), hindgut (n = 1), and unknown site (n = 3). Most cases had liver metastasis. Seventeen patients had elevated 5-hydroxyindoloacetic acid (5-HIAA) excretion and 5 had flushing and/or diarrhea as the only clinical manifestation. Six cases presented a complete syndrome (flushing, diarrhea and 5-HIAA excretion). Control of symptoms was obtained in 80% and a 5-HIAA level reduction in 58% of the patients. The interferon treatment was more effective for control of the carcinoid syndrome than for control of tumor growth. The treatment was well tolerated and fever, myalgia, anorexia and fatigue were the most frequent side-effects.
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PMID:Treatment of carcinoid syndrome with recombinant interferon alpha-2a. 768 66

The manifestations of carcinoid syndrome result from a variety of hormones secreted by the carcinoid tumour. The minority of patients with carcinoid tumour suffer bronchospasm and flushing. In this report the possibility of carcinoid syndrome in a patient who developed severe bronchospasm during operative manipulation of his rectal carcinoid is discussed.
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PMID:Severe bronchospasm during rectal carcinoid resection. 778 71

Carcinoid tumors stimulate the release of specific hormones that lead to flushing, diarrhea, and bronchospasm. Serotonin is the most significant of these substances. Recently, a somatostatin analogue as well as the longer acting octreotide have been used to inhibit tumor secretions and reduce their untoward actions. This is a case report in which somatostatin was used perioperatively for removal of carcinoid tumors with an uneventful course.
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PMID:Carcinoid syndrome. 790 89

Right-sided valvular heart disease is a common complication of metastatic carcinoid tumors. On the contrary, left valve involvement is a rare finding. In our report we describe a patient in whom the subsequent involvement of right and left heart valves was documented by 2D and Doppler echocardiography. The patient was a 46-year-old woman who, in the last three years, complained of face flushing, postprandial diarrhea and shooting epigastric pain lasting for hours. She came at our observation for increasing dyspnoea, peripheral edemas and asthenia. 2D-echocardiography and Color Doppler revealed a severe tricuspid regurgitation and a turbulent blood flow across the pulmonary valve. An Angiographic examination confirmed the severe tricuspidal regurgitation and disclosed a mild pulmonary stenosis. These findings were associated with high 5 hydroxyndole acetic acid (5-HIAA) urinary excretion and the presence of a liver metastasizing ileal carcinoid tumor. Some months later, a new 2D echo-Doppler examination showed thickening and reduced motion of the posterior mitral leaflet, associated with regurgitation and an aortic insufficiency without evident structural valvular abnormalities. Even if carefully investigated no right-to-left shunt was found.
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PMID:[Left valvular involvement in carcinoid: description of a case]. 805 18

Neuroendocrine gut and pancreatic tumors have over the years presented a therapeutic challenge. The patients present with a wide range of clinical symptoms related to hormone production that can sometimes be easily managed but are sometimes life threatening. The most frequent clinical symptom related to endocrine gut tumors is the carcinoid syndrome, with flushing, diarrhea, bronchoconstriction, and right heart failure. Until the middle of the 1980s, when a patient was not cured by surgery, very little could be offered except chemotherapy. Biotherapy has revolutionized the treatment of malignant neuroendocrine gut and pancreatic tumors, in which both interferon-alpha and somatostatin analogues improved the quality of life for these patients and possibly also increased survival. Chemotherapy, with response rates of 40% to 60% in endocrine pancreatic tumors, is still first-line treatment in this group of patients, whereas in patients with carcinoids of the gut, no beneficial value of chemotherapy so far has been noticed. Both interferon-alpha and somatostatin analogues provide biochemical responses in 40% to 70% of patients with carcinoid tumors, whereas significant tumor reduction is only noticed in a few cases. Development of biotherapy is just at its beginning, and in the future, when we have learned more about tumor biology and mechanisms of action of these treatments, even better therapeutic results might be encountered. Combinations of biotherapy with chemotherapy as well as combinations of different biotherapies are now under clinical investigation.
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PMID:Chemotherapy and biotherapy in neuroendocrine tumors. 809 14


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