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Pancreatic carcinoid - Symptoms
Medical expert of the article
Last reviewed: 04.07.2025
Symptoms of carcinoid are caused primarily by 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 hypermotility. With debilitating diarrhea, there is a large loss of fluid, protein, and electrolytes. Therefore, in severe cases of the disease, hypovolemia, electrolyte disturbances, hypoproteinemia, and oliguria may develop.
Complete carcinoid syndrome - flushes, diarrhea, endocardial fibrosis, asthmatic attacks - is observed in hardly every fifth patient with carcinoid. In a typical flush attack, the face, back of the head, neck, upper body turn red, there is a feeling of heat and burning in these areas, paresthesia, often - conjunctival injection, increased lacrimation and salivation, periorbital edema and facial edema, tachycardia and decreased blood pressure. Hyperemia of the skin can develop into prolonged spotted cyanosis with cold skin and sometimes increased blood pressure.
At the onset of the disease, many patients experience intervals between hot flashes that last several weeks, even months. Subsequently, hot flashes become more frequent, recurring dozens of times (up to 30) per day. The duration of an attack ranges from one to 10 minutes.
Hot flashes develop spontaneously or after emotional or physical stress, consumption of alcohol, fat, meat, certain types of cheese (cheddar), after pressure on a tumor, or the administration of a number of medications (reserpine, histamine, catecholamines).
Hot flashes are usually observed only in the presence of liver metastases, when the metabolism of the increased amount of serotonin and other biologically active substances produced by the tumor and metastases is disrupted. During hot flashes, an increase in the concentration of serotonin in the blood is detected. In patients with hot flashes, an increase in the daily excretion of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) in the urine is detected.
Currently, the pathogenesis of hot flashes is explained not so much by the action of serotonin, but by the influence of other vasoactive substances. Kallikreinogen formed in liver metastases can enter the bloodstream, be activated and, by influencing the quinine system, increasing the formation of vasoactive bradykinin, cause hot flashes. The participation of other vasoactive substances in the genesis of vascular reactions in carcinoid syndrome is not excluded, such as prostaglandins, substance P, etc.
Approximately half of patients with carcinoid syndrome develop irreversible endocardial fibrosis. Characteristic is predominant damage to the right heart. It is possible to develop pulmonary trunk stenosis and right atrioventricular (tricuspid) valve insufficiency, leading to progressive, therapy-resistant right-sided heart failure.
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