Carcinoid - Symptoms

The main clinical and laboratory manifestations of carcinoid:

• attacks of hot flashes in the face, neck, chest - the face, back of the head, neck, upper body suddenly turn red. In these areas, the patient feels a burning sensation, a feeling of heat, numbness. Many patients experience reddening of the eyes (conjunctival injection), increased lacrimation, hypersalivation, swelling of the face, tachycardia; a significant decrease in blood pressure is possible. At the onset of the disease, hot flashes are rare (1-2 times in 1-2 weeks or even in 1-3 months), later they become daily and can bother patients 10-20 times a day. The duration of hot flashes varies from one to 5-10 minutes. Hot flashes can appear quite suddenly, without any apparent reason, but they are often provoked by physical or emotional overexertion, alcohol consumption, fatty, meaty foods, cheddar cheese, medications - reserpine, histamine (they increase the release of serotonin). Hot flashes are much more pronounced and are more often observed when the tumor metastasizes to the liver (in this case, the degradation of serotonin in the liver is disrupted);
• Diarrhea is a characteristic symptom of carcinoid syndrome; it is caused by a significant increase in small intestinal motility under the influence of serotonin. Diarrhea can be very severe, with large amounts of water (water diarrhea), protein, and electrolytes (sodium, potassium, calcium) being excreted with the feces; hypoproteinemia, hypovolemia (with decreased blood pressure), hyponatemia, hypochloremia, hypokalemia, and hypocalcemia may develop;
• bronchospasm - observed in many patients, manifested by an attack of expiratory dyspnea, dry whistling and buzzing rales during auscultation of the lungs;
• endocardial fibrosis - develops in 50% of patients; the right heart chambers are predominantly affected, which leads to the development of tricuspid valve insufficiency and right ventricular circulatory failure. Some patients develop pulmonary artery stenosis;

A carcinoid tumor, as a potentially malignant tumor, can metastasize to various organs, including the liver. Leningrad scientists A. A. Nikonov and D. B. Tsikin (1977) described 8 cases of carcinoid in various parts of the digestive tract with metastases to the liver. In one case, signs of carcinoid syndrome were absent, but sudden jaundice, hepatomegaly, and a significant increase in transaminase activity in the blood serum suggested a diagnosis of acute viral hepatitis. However, a puncture biopsy of the liver and subsequent histological examination of the biopsy specimens revealed tumor cells, which were then identified as carcinoid cells during a special study. A carcinoid tumor of the duodenum was discovered during surgery. In another case described by them, the symptoms of the disease for several years were considered as a manifestation of chronic cholecystitis, but then rapid progression - significant weight loss, enlargement of the liver with a lumpy surface allowed them to suspect a tumor disease. It turned out to be a gastric carcinoid with multiple metastases to the liver.

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