Faces of the carcinoid syndrome in patients with hypertension

Abstract

Background Carcinoids are neuroendocrine tumors which develop in many different parts of gastrointestinal tract and lungs. They occur with the frequency of 1-3/ 100 000 Their common feature is the ability to production and secretion of hormone-like peptides and neurotransmitters. The carcinoid syndrome is caused by dissemination of serotonin producing neuroendocrine tumor. Symptoms of carcinoid, such as: skin redness on the face and neck - flash, tachycardia, vertiges, hyperhidrose and bronchospasm are paroxysmal (periodic). Blood pressure elevation is not a patognomic sign of carcinoid, but if it is, one should be classified as secondary cause of arterial hypertension. The measurement of: serotonin, it’s metabolite in the urine-5-hydroxyindoloacetic acid, chromogranin A levels and computed tomography, nuclear magnetic resonance, ultrasonography, somatostatin receptor scintigraphy (SRS) are crucial in the diagnostic process of carcinoid and in localization of metastases. Material and methods Sixty four-years old man was admitted to the hospital because of cough attacks with slight production of sputum which contained small amount of blood, diarrhea, abdominal pain, paroxysmal redness of the face and high blood pressure. Another patient, 69-years old woman was hospitalized because of dyspnea, fatigue and high blood pressure. Results The first patient’s bronchoscopy revealed lesion confirming the diagnosis of carcinoid which was removed from division of the left bronchus. In case of the second patient with heart failure, tricuspid valve pathology and redness of the face, SRS was performed. It revealed focal increase in radio-accumulation in the patient’s body, what was the reason of starting the therapy with long-acting release somatostatin. The echosonography revealed advanced complex tricuspid valve defect. Conclusions In these two cases the carcinoid syndrome was diagnosed. During the both patients’observation, the blood pressure was normalized, but the regression of the carcinoid syndrome process wasn’t achieved.
Arterial Hypertension 2010, vol. 14, no 3, pages 227-234