Skip to main content
SpringerLink
Log in

Carcinoid Crisis in the Intensive Care Unit

  • Living reference work entry
  • First Online:
Oncologic Critical Care

Abstract

Carcinoid tumors are slow-growing, usually asymptomatic neuroendocrine tumors of enterochromaffin cell origin. Functional neuroendocrine tumors secrete many different mediators such as histamine, 5-hydroxytryptamine (serotonin), and 5-hydroxytryptophan. Carcinoid syndrome is characterized by episodic flushing, diarrhea, wheezing, and right heart valve disease due to these mediators. Carcinoid crisis is a very serious complication of carcinoid syndrome and defined as the severe combination of carcinoid syndrome symptoms. The risk of carcinoid crisis varies between 3.4% and 24%. There are many factors triggering the carcinoid crisis. The most common cause is anesthesia and surgery.

There are no well-defined predicting risk factors for the development of carcinoid crisis. However there are some risk factors such as presence of carcinoid syndrome, elevated 5-HIAA, high tumor burden, metastatic disease, carcinoid heart disease, liver metastases, duration of anesthesia, and advanced patient age.

The aim of the treatment of carcinoid crisis is to block the secretion and effect of mediators released by the tumor and control the symptoms. The cornerstone of this treatment is somatostatin analogs. Other drugs used in the treatment of carcinoid crisis are methylene blue, ketanserin, and H1 and H2 receptor antagonists.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Condron ME, Pommier SJ, Pommier RF. Continuous infusion of octreotide combined with perioperative octreotide bolus does not prevent intraoperative carcinoid crisis. Surgery. 2016;159(1):358–65.

    Article  Google Scholar 

  2. Davì MV, Bodei L, Francia G, et al. Carcinoid crisis induced by receptor radionuclide therapy with 90Y-DOTATOC in a case of liver metastases from bronchial neuroendocrine tumor (atypical carcinoid). J Endocrinol Investig. 2006;29(6):563–7.

    Article  Google Scholar 

  3. Fujie S, Zhou W, Fann P, et al. Carcinoid crisis 24 hours after bland embolization: a case report. Biosci Trends. 2010;4(3):143–4.

    CAS  PubMed  Google Scholar 

  4. Guo LJ, Tang CW. Somatostatin analogues do not prevent carcinoid crisis. Asian Pac J Cancer Prev. 2014;15(16):6679–83.

    Article  Google Scholar 

  5. Hyman AL, Kadowitz PJ, Lippton HL. Methylene blue selectively inhibits pulmonary vasodilator responses in cats. J Appl Physiol (1985). 1985;66(3):1513–7.

    Article  Google Scholar 

  6. Janssen M, Salm EF, Breburda CS, et al. Carcinoid crisis during transedophageal echocardiography. Intensive Care Med. 2000;26(2):254.

    Article  CAS  Google Scholar 

  7. Kılıçkap S, Yalcin S. Introduction to neuroendocrine tumors. In: Yalcin S, editor. Carcinoid syndrome: Springer, Heidelberg; 2015. p. 513–22.

    Google Scholar 

  8. Kinney MA, Warner ME, Nagorney DM, et al. Perianaesthetic risks and outcomes of abdominal surgery for metastatic carcinoid tumours. Br J Anaesth. 2001;87(3):447–52.

    Article  CAS  Google Scholar 

  9. Koopmans KP, Brouwers AH, De Hooge MN, et al. Carcinoid crisis after injection of 6-18F-fluorodihydroxyphenylalanine in a patient with metastatic carcinoid. J Nucl Med. 2005;46(7):1240–3.

    PubMed  Google Scholar 

  10. Kromas M, Passi Y, Kuzumi C, et al. Intraoperative carcinoid crisis: revised anaesthesia management. Ind J Anaesth. 2017;61(5):85–6.

    Google Scholar 

  11. Kunz PL, Reidy-Lagunes D, Anthony LB, et al. Consensus guidelines for the management and treatment of neuroendocrine tumors. Pancreas. 2013;42(4):557–77.

    Article  Google Scholar 

  12. Kvols LK, Martin JK, Marsh HM, et al. Rapid reversal of carcinoid crisis with a somatostatin analogue. N Engl J Med. 1985;313:1229–30.

    CAS  PubMed  Google Scholar 

  13. Lyseng-Williamson KA. Telotristat ethyl: a review in carcinoid syndrome diarrhoea. Drugs. 2018;78(9): 941–50.

    Article  CAS  Google Scholar 

  14. Magabe PC, Bloom AL. Sudden death from carcinoid crisis during image-guided biopsy of a lung mass. J Vasc Interv Radiol. 2014;25(3):484–7.

    Article  Google Scholar 

  15. Majeed F, Porter TR, Tarantolo S, et al. Carcinoid crisis and reversible right ventricular dysfunction after embolization in untreated carcinoid syndrome. Eur J Echocardiogr. 2007;8(5):386–9.

    Article  Google Scholar 

  16. Massimino K, Harrskog O, Pommier S, et al. Octreotide LAR and bolus octreotide are insufficient for preventing intraoperative complications in carcinoid patients. J Surg Oncol. 2013;107(8):842–6.

    Article  CAS  Google Scholar 

  17. Mehta AC, Rafanan AL, Bulkley R, et al. Coronary spasm and cardiac arrest from carcinoid crisis during laser bronchoscopy. Chest. 1999;115(2):598–600.

    Article  CAS  Google Scholar 

  18. Morrisroe K, Sim I-W, Mc Lachlan K, et al. Carcinoid crisis induced by repeated abdominal examination. Intern Med J. 2012;42(3):342–3.

    Article  CAS  Google Scholar 

  19. Phan AT, Oberg K, Choi J, et al. NANETS consensus guideline for the diagnosis and management of neuroendocrine tumors: well-differentiated neuroendocrine tumors of the thorax (includes lung and thymus). Pancreas. 2010;39(6):784–98.

    Article  Google Scholar 

  20. Raikhelkar JK, Weiss AJ, Maysick L, et al. Adjuvant therapy with methylene blue in the treatment of postoperative vasoplegic syndrome caused by carcinoid crisis after tricuspid valve replacement. J Cardiothorac Vasc Anesth. 2012;26(5):878–9.

    Article  Google Scholar 

  21. Shapiro MB, Endredi J, Ehrhart IC, et al. Methylene blue restores vasodilation to bradykinin after inhibition of nitric oxide production in the isolated dog lung. J Vasc Res. 1996;33(4):340–5.

    Article  CAS  Google Scholar 

  22. Seymour N, Sawh SC. Mega-dose intravenous octreotide for the treatment of carcinoid crisis: a systematic review. Can J Anaesth. 2013;60(5):492–9.

    Article  Google Scholar 

  23. Sinha V, Dyer P, Shuvro RC, et al. Case of carcinoid crisis following a fine-needle biopsy of hepatic metastasis. Eur J Gastroenterol Hepatol. 2009;21(1):101–3.

    Article  Google Scholar 

  24. Soto Herrera M, Restrepo JA, Díaz JH, et al. Reversible right-sided heart failure secondary to carcinoid crisis. Case Rep Crit Care. 2013;2013:487801.

    PubMed  PubMed Central  Google Scholar 

  25. Tapia Rico G, Li M, Pavlakis N, et al. Prevention and management of carcinoid crises in patients with high-risk neuroendocrine tumours undergoing peptide receptor radionuclide therapy (PRRT): literature review and case series from two Australian tertiary medical institutions. Cancer Treat Rev. 2018;66:1–6.

    Article  Google Scholar 

  26. van Diepen S, Sobey A, Lewanczuk R, et al. A case of acute respiratory distress syndrome responsive to methylene blue during a carcinoid crisis. Can J Anaesth. 2013;60(11):1085–8.

    Article  Google Scholar 

  27. Woltering EA, Wright AE, Stevens MA, et al. Development of effective prophylaxis against intraoperative carcinoid crisis. J Clin Anaesth. 2016;32:189–93.

    Article  CAS  Google Scholar 

  28. Yalcin S, Öberg K. Introduction to neuroendocrine tumors. In: Yalcin S, editor. Neuroendocrine tumors: diagnosis and management: Springer, Heidelberg; 2015. p. 1–5.

    Google Scholar 

  29. Yazbek-Karam VG, Haswani RW, Mousallem NM, et al. Severe intra-operative carcinoid crisis in a patient having carcinoid heart disease. Acta Anaesthesiol Scand. 2009;53(3):414–5.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical Oncology, Selçuk University, Konya, Turkey

    Ozge Keskin

  2. Department of medical oncology, Hacettepe University Institute of Cancer, Ankara, Turkey

    Suayib Yalcin

Authors
  1. Ozge Keskin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Suayib Yalcin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Suayib Yalcin .

Editor information

Editors and Affiliations

  1. Department of Critical Care, University of Texas MD Anderson Cancer C Department of Critical Care, Houston, TX, USA

    Joseph L. Nates

  2. Department of Critical Care, University of Texas MD Anderson Cancer C Department of Critical Care, Houston, TX, USA

    Kristen J. Price

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Keskin, O., Yalcin, S. (2019). Carcinoid Crisis in the Intensive Care Unit. In: Nates, J., Price, K. (eds) Oncologic Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-74698-2_82-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-74698-2_82-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74698-2

  • Online ISBN: 978-3-319-74698-2

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation