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A prospective study of the pathophysiology of carcinoid crisis.
Condron, Mary E; Jameson, Nora E; Limbach, Kristen E; Bingham, Ann E; Sera, Valerie A; Anderson, Ryan B; Schenning, Katie J; Yockelson, Shaun; Harukuni, Izumi; Kahl, Edward A; Dewey, Elizabeth; Pommier, SuEllen J; Pommier, Rodney F.
Affiliation
  • Condron ME; Division of Surgical Oncology, Oregon Health & Science University, Portland.
  • Jameson NE; Division of Surgical Oncology, Oregon Health & Science University, Portland.
  • Limbach KE; Division of Surgical Oncology, Oregon Health & Science University, Portland.
  • Bingham AE; Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland.
  • Sera VA; Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland.
  • Anderson RB; Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland.
  • Schenning KJ; Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland.
  • Yockelson S; Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland.
  • Harukuni I; Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland.
  • Kahl EA; Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland.
  • Dewey E; Division of Surgical Oncology, Oregon Health & Science University, Portland.
  • Pommier SJ; Division of Surgical Oncology, Oregon Health & Science University, Portland.
  • Pommier RF; Division of Surgical Oncology, Oregon Health & Science University, Portland. Electronic address: pommierr@ohsu.edu.
Surgery ; 165(1): 158-165, 2019 01.
Article in En | MEDLINE | ID: mdl-30415870
ABSTRACT

BACKGROUND:

Sudden massive release of serotonin, histamine, kallikrein, and bradykinin is postulated to cause an intraoperative carcinoid crisis. The exact roles of each of these possible agents, however, remain unknown. Optimal treatment will require an improved understanding of the pathophysiology of the carcinoid crisis.

METHODS:

Carcinoid patients with liver metastases undergoing elective abdominal operations were studied prospectively, using intraoperative, transesophageal echocardiography, pulmonary artery catheterization, and intraoperative blood collection. Serotonin, histamine, kallikrein, and bradykinin levels were analyzed by enzyme-linked immunosorbent assay.

RESULTS:

Of 46 patients studied, 16 had intraoperative hypotensive crises. Preincision serotonin levels were greater in patients who had crises (1,064 vs 453 ng/mL, P = .0064). Preincision hormone profiles were otherwise diverse. Cardiac function on transesophageal echocardiography during the crisis was normal, but intracardiac hypovolemia was observed consistently. Pulmonary artery pressure decreased during crises (P = .025). Linear regression of preincision serotonin levels showed a positive relationship with mid-crisis cardiac index (r = 0.73, P = .017) and a negative relationship with systemic vascular resistance (r=-0.61, P = .015). There were no statistically significant increases of serotonin, histamine, kallikrein, or bradykinin levels during the crises.

CONCLUSION:

The pathophysiology of carcinoid crisis appears consistent with distributive shock. Hormonal secretion from carcinoid tumors varies widely, but increased preincision serotonin levels correlate with crises and with hemodynamic parameters during the crises. Statistically significant increases of serotonin, histamine, kallikrein, or bradykinin during the crises were not observed.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Pulmonary Artery / Serotonin / Hypovolemia / Hypotension / Malignant Carcinoid Syndrome Type of study: Observational_studies Limits: Female / Humans / Male / Middle aged Language: En Journal: Surgery Year: 2019 Document type: Article

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Pulmonary Artery / Serotonin / Hypovolemia / Hypotension / Malignant Carcinoid Syndrome Type of study: Observational_studies Limits: Female / Humans / Male / Middle aged Language: En Journal: Surgery Year: 2019 Document type: Article