Pancreatic carcinoid: symptoms
Last reviewed: 23.04.2024
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Symptoms of carcinoid are primarily due to products secreted by the tumor, primarily serotonin. The leading symptoms of pancreatic carcinoid are abdominal pain and watery diarrhea. It is known that serotonin causes intestinal hypermotorics. When exhausting diarrhea occurs a large loss of fluid, protein, electrolytes. Therefore, in severe cases of the disease may develop hypovolemia, electrolyte disorders, hypoproteinemia, oliguria.
Complete carcinoid syndrome - hot flashes, diarrhea, endocardial fibrosis, asthmatic attacks - is hardly observed in every fifth patient with carcinoid. With a typical bout of the tide, face, neck, neck, upper body blush, there is a feeling of heat and burning in these areas, paresthesia, often conjunctiva injection, increased tear and salivation, periorbital edema and face swelling, tachycardia and lowering of blood pressure. Hyperemia of the skin can pass into prolonged spotted cyanosis with a cooling of the skin and sometimes an increase in blood pressure.
At the onset of the disease, many patients have tidal intervals of several weeks, even months. In the future, the tides become more frequent, resuming dozens of times (up to 30) a day. The duration of the attack ranges from one to 10 minutes.
Tides develop spontaneously or after emotional, physical overstrain, consumption of alcohol, fat, meat food, certain types of cheese (cheddar), after pressure on the tumor, the introduction of a number of medicines (reserpine, histamine, catecholamines).
Tides are observed, as a rule, only in the presence of metastases in the liver, when the metabolism in it of the increased amount of serotonin and other biologically active substances produced by the tumor and metastases is disturbed. During high tides there is an increase in serotonin concentration in the blood. In patients with hot flashes, an increase in daily urinary excretion of the serotonin metabolite of 5-hydroxyindoleacetic acid (5-GOIUK) is revealed.
Currently, the pathogenesis of tides is explained not so much by the action of serotonin as by the influence of other vasoactive substances. Formed in hepatic metastases, kallikreinogen can enter the bloodstream, and be activated by affecting the quinine system, increasing the formation of vasoactive bradykinin, causing hot flashes. It is not excluded participation in the genesis of vascular reactions with carcinoid syndrome and other vascular substances, for example prostaglandins, substances P, etc.
Approximately half of patients with carcinoid syndrome develop irreversible endocardial fibrosis. Characteristic is the primary lesion of the right heart. Perhaps the development of stenosis of the pulmonary trunk and the inadequacy of the right atrioventricular (tricuspid) valve, leading to progressive, resistant to therapy, right-sided heart failure.
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