Case Reports
Sunday, November 12, 2023
12:45 PM–02:15 PM
Abstract
Introduction:
Carcinoid crisis is a rare, life-threatening, difficult to recognize complication associated with neuroendocrine tumors. We discuss a case of known cardiac carcinoid syndrome, progressing to carcinoid crisis, potentially stemming from prior treatment with peptide receptor radionuclide therapy.
Case:
Our patient was a 65-year-old male with a new diagnosis of metastatic stage IV ileal neuroendocrine tumor and cardiac carcinoid syndrome. Chemotherapy was started after diagnosis, in addition to peptide receptor radionuclide therapy. Approximately two weeks after initiating chemotherapy, the patient presented to the emergency department with persistent nausea, vomiting, diarrhea, worsening palpitations, and skin flushing, concerning for carcinoid crisis. The patient was initiated on amiodarone and octreotide infusions, admitted to the hospital, but ultimately expired.
Discussion:
The increasing use of peptide receptor radionuclide therapy has contributed to increases in carcinoid crisis, especially in high-risk patients. The presentation of carcinoid crisis is highly variable, rare, and unpredictable with no consensus on an appropriate definition or diagnostic criteria. Patients with carcinoid crisis often present to the emergency department, making recognition and timely management critical. Therapeutic management of crisis largely consists of octreotide infusion, intravenous fluids, corticosteroids, and correction of electrolyte disturbances. While these strategies are currently the mainstay of crisis management, there are no consensus-based guidelines for management.
Conclusion:
Our patient was at high risk of developing carcinoid crisis, and his presentation was consistent with other case reports describing this condition. This case adds to the growing literature supporting carcinoid crisis as a complication of peptide receptor radionuclide therapy. As this therapy continues to be used as a mainstay of neuroendocrine tumors, emergency department providers are likely to encounter this cancer-related emergency more often. Timely recognition is critical, and further research should be directed at better understanding the pathophysiologic mechanisms responsible for carcinoid crisis to reach a consensus on definitions, diagnostic criteria, and goal-directed treatment strategies.
Presenting Author
Mandy Jones PharmD, MPASUniversity of Kentucky College of Pharmacy
Authors
Regan Baum PharmD
University of Kentucky HealthCare
Andrew Micciche MD
University of Kentucky HealthCare
Alex Peterson MD
University of Kentucky HealthCare
Mallory Schwartz BS
University of Kentucky College of Pharmacy