Facies leonina en el síndrome carcinoide / Leonine Facies in Carcinoid Syndrome

El síndrome carcinoide es un proceso infrecuente que se produce por la presencia en el organismo de niveles elevados de sustancias vasoactivas secretadas por un tumor carcinoide y no metabolizadas por el hígado, debido a diversas circunstancias, entre ellas la invasión metastásica del mismo. Se traduce en una elevación del 5-hidroxi-indol-acético en orina. Clínicamente cursa con síntomas cutáneos (episodios de rubefacción-flushing), digestivos (diarrea), respiratorios (broncoespasmo) y cardiovasculares (insuficiencia cardiaca). Describimos el caso de un paciente con síndrome carcinoide con metástasis hepáticas cuyo síntoma guía fue el edema facial, que se hizo persistente otorgándole una facies leonina muy llamativa, que respondió parcialmente al tratamiento con isotretinoína por vía oral y lanreótida intramuscular. Realizamos diagnóstico diferencial con otros cuadros que cursan con edema facial y revisamos las diversas manifestaciones cutáneas que pueden surgir en el síndrome carcinoide, destacando su importancia para realizar un diagnóstico y tratamiento precoces del proceso (AU)

Carcinoid syndrome is a rare disorder caused when elevated levels of vasoactive substances secreted by a carcinoid tumor fail to be metabolized by the liver. This can occur for a variety of reasons including metastatic invasion of the organ. Carcinoid syndrome results in elevated levels of 5-hydroxyindoleacetic acid in the urine. Clinical manifestations include: flushing, diarrhea, bronchospasm, and heart failure. We describe a patient with carcinoid syndrome and hepatic metastases, in whom the key symptom of persistent facial edema resulted in conspicuous leonine facies; there was a partial response to treatment with oral isotretinoin and intramuscular lanreotide. Differential diagnosis was made with other conditions causing facial edema. A review is performed of the various skin manifestations of carcinoid syndrome, highlighting their role in the early diagnosis and treatment of the disorder (AU)

Metabolism of oral 9-cis-retinoic acid in the human. Identification of 9-cis-retinoyl-beta-glucuronide and 9-cis-4-oxo-retinoyl-beta-glucuronide as urinary metabolites.

Data from a number of investigators suggest that the 9-cis-isomer of RA1 (9-cis-RA) may be a promising agent in chemoprevention and treatment of certain types of cancer. Therefore, clinical studies on this retinoid have been initiated. However, up to now, no information has been published on the metabolism of 9-cis-RA in the human. Herein, we report the first data on retinoid metabolism after multiple administration of 9-cis-RA (20 mg/day po) to human volunteers. After 2 and 12-13 hr, plasma concentrations of 9-cis-RA and its metabolites 9,13-dicis-RA, 13-cis-RA, and all-trans-RA were low. In contrast, dosing with 13-cis-RA yielded much higher plasma retinoid levels. Effects on plasma retinol concentrations did not become obvious after any drug treatment. Several retinoid metabolites were found in the urine of 9-cis-RA-treated individuals, and 9-cis-RAG, as well as 9-cis-4-oxo-RAG, could be identified. After treatment with 9-cis-RA, high concentrations of the administered drug were found in the feces, along with comparably low concentrations of 13-cis-RA, 9,13-dicis-RA, and all-trans-RA. Our report indicates that 9-cis-RA is either eliminated much more rapidly than 13-cis-RA, or it is poorly absorbed, and presents the characterization of two urinary glucuronides.