Aspects on Diagnosis and Treatment of the Foregut Carcinoid Syndrome

H. Ahlman Depts. of Surgery, Anesthesiology, and Histology, University of Göteborg, Göteborg;, ConnecticutUSA; Dept. of Pathology, University of Uppsala, Uppsala; and Dept. of Clinical Physiology, University of Linköping, Linköping;, Sweden; Dept. of Surgery, Yale University, New Haven, ConnecticutUSA

B. Wängberg Depts. of Surgery, Anesthesiology, and Histology, University of Göteborg, Göteborg;, ConnecticutUSA; Dept. of Pathology, University of Uppsala, Uppsala; and Dept. of Clinical Physiology, University of Linköping, Linköping;, Sweden; Dept. of Surgery, Yale University, New Haven, ConnecticutUSA

O. Nilsson Depts. of Surgery, Anesthesiology, and Histology, University of Göteborg, Göteborg;, ConnecticutUSA; Dept. of Pathology, University of Uppsala, Uppsala; and Dept. of Clinical Physiology, University of Linköping, Linköping;, Sweden; Dept. of Surgery, Yale University, New Haven, ConnecticutUSA

L. Grimelius Depts. of Surgery, Anesthesiology, and Histology, University of Göteborg, Göteborg;, ConnecticutUSA; Dept. of Pathology, University of Uppsala, Uppsala; and Dept. of Clinical Physiology, University of Linköping, Linköping;, Sweden; Dept. of Surgery, Yale University, New Haven, ConnecticutUSA

G. Granérus Depts. of Surgery, Anesthesiology, and Histology, University of Göteborg, Göteborg;, ConnecticutUSA; Dept. of Pathology, University of Uppsala, Uppsala; and Dept. of Clinical Physiology, University of Linköping, Linköping;, Sweden; Dept. of Surgery, Yale University, New Haven, ConnecticutUSA

I. M. Modlin Depts. of Surgery, Anesthesiology, and Histology, University of Göteborg, Göteborg;, ConnecticutUSA; Dept. of Pathology, University of Uppsala, Uppsala; and Dept. of Clinical Physiology, University of Linköping, Linköping;, Sweden; Dept. of Surgery, Yale University, New Haven, ConnecticutUSA

O. Stenqvist Depts. of Surgery, Anesthesiology, and Histology, University of Göteborg, Göteborg;, ConnecticutUSA; Dept. of Pathology, University of Uppsala, Uppsala; and Dept. of Clinical Physiology, University of Linköping, Linköping;, Sweden; Dept. of Surgery, Yale University, New Haven, ConnecticutUSA

T. Scherstén Depts. of Surgery, Anesthesiology, and Histology, University of Göteborg, Göteborg;, ConnecticutUSA; Dept. of Pathology, University of Uppsala, Uppsala; and Dept. of Clinical Physiology, University of Linköping, Linköping;, Sweden; Dept. of Surgery, Yale University, New Haven, ConnecticutUSA

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Abstract

Eight patients with the foregut carcinoid syndrome (two gastric and six bronchial primary tumors) are reported. The patients presented with complex clinical symptoms including ectopic production of adrenocorticotrophic hormone and growth hormone-releasing factors. The most alarming symptoms were facial flush and edema, accompanied by severe bronchoconstriction, which easily was misinterpreted as asthmatic attacks. Conventional bronchodilatory drugs may be potentially dangerous in these patients, in whom combined blockade of histamine receptors and treatment with cortisone and octreotide are recommended. Owing to the patients' age and general condition individualized long-term therapy was instituted. Surgical therapy under optimal protection by drugs can be of substantial value also in patients with advanced disease. One patient with life-threatening hormonal symptoms underwent hyperthermic perfusion of the liver with cytotoxic drugs, resulting in good palliation.

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Aspects on Diagnosis and Treatment of the Foregut Carcinoid Syndrome

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