A prospective study of the pathophysiology of carcinoid crisis
| Autor: | Shaun Yockelson, Rodney F. Pommier, Kristen E. Limbach, Valerie Sera, Nora E. Jameson, Katie J. Schenning, Edward A. Kahl, Mary E. Condron, Elizabeth N. Dewey, Ann E. Bingham, Izumi Harukuni, Su Ellen J. Pommier, Ryan B. Anderson |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Serotonin Lung Neoplasms Carcinoid tumors Hypovolemia Bradykinin Hemodynamics Carcinoid Tumor 030230 surgery Pulmonary Artery 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Postoperative Complications medicine.artery Internal medicine Intestinal Neoplasms medicine Humans Prospective Studies Intraoperative Complications Malignant Carcinoid Syndrome business.industry Liver Neoplasms Middle Aged medicine.disease Distributive shock medicine.anatomical_structure chemistry 030220 oncology & carcinogenesis Pulmonary artery Cardiology Vascular resistance Surgery Female Kallikreins medicine.symptom Hypotension business Echocardiography Transesophageal Histamine |
| Zdroj: | Surgery. 165(1) |
| ISSN: | 1532-7361 |
| Popis: | Background Sudden massive release of serotonin, histamine, kallikrein, and bradykinin is postulated to cause an intraoperative carcinoid crisis. The exact roles of each of these possible agents, however, remain unknown. Optimal treatment will require an improved understanding of the pathophysiology of the carcinoid crisis. Methods Carcinoid patients with liver metastases undergoing elective abdominal operations were studied prospectively, using intraoperative, transesophageal echocardiography, pulmonary artery catheterization, and intraoperative blood collection. Serotonin, histamine, kallikrein, and bradykinin levels were analyzed by enzyme-linked immunosorbent assay. Results Of 46 patients studied, 16 had intraoperative hypotensive crises. Preincision serotonin levels were greater in patients who had crises (1,064 vs 453 ng/mL, P = .0064). Preincision hormone profiles were otherwise diverse. Cardiac function on transesophageal echocardiography during the crisis was normal, but intracardiac hypovolemia was observed consistently. Pulmonary artery pressure decreased during crises (P = .025). Linear regression of preincision serotonin levels showed a positive relationship with mid-crisis cardiac index (r = 0.73, P = .017) and a negative relationship with systemic vascular resistance (r=-0.61, P = .015). There were no statistically significant increases of serotonin, histamine, kallikrein, or bradykinin levels during the crises. Conclusion The pathophysiology of carcinoid crisis appears consistent with distributive shock. Hormonal secretion from carcinoid tumors varies widely, but increased preincision serotonin levels correlate with crises and with hemodynamic parameters during the crises. Statistically significant increases of serotonin, histamine, kallikrein, or bradykinin during the crises were not observed. |
| Databáze: | OpenAIRE |
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