Carcinoid syndrome

The emergence of carcinoid syndrome is determined by several reasons. Essential: the slow growth of the primary tumor, massive metastasis and the size of metastases. However, plays a decisive role extraportion the location of the latter. All these factors contribute to a hypersecretion of serotonin and other biologically active substances, which periodically go into the blood stream and have a pathological effects on different organs and systems.
The most typical group vasomotor disorders include so-called "syndrome redness" (flushing syndrome), detailed and Waldenstrom Thorson. First and foremost periodic "redness" of the face, shoulders, upper half of the body, accompanied by a burning sensation, fever, tachycardia, tachycardia, a sense of weakness, sometimes by profuse sweating. The color of the skin suddenly becomes bright red, and then quickly replaced pink and goes to the normal colour. Often the skin stain of cyanosis ("spotted cyanosis) on the background of the General pallor. Such an attack may take anywhere from 30 seconds to 10 minutes. During the day the patient is from 5 to 30 such attacks.
Provoking factors for "syndrome redness" are: emotional and physical stress, rich, hot food, taking alcohol, defecation.
Over time, hyperemia skin may become permanent, cyanosis progressing, and remind patients of their appearance patients with polycythemia (platonicheskaya habitus). Sometimes there telangiectasias.
Cyanotic phase attack redness some researchers are trying to explain the possible synergistic effects on the vascular system of serotonin and bradikinina, while also introducing them to rats occurred spasm venules and retrograde spasm of blood in capillaries (Weiner and Altura, 1967).
Episodes of redness gastric carcinoids begin with bright red focal erythema with clearly defined borders. Apparently, in most of these cases, in addition to serotonin, periodically in the blood come, significant quantities of histamine and 5-hydroxytryptophan - a precursor to serotonin. The predominant formation of tumor tissue last due to the deficit of decarboxylase for synthesis of serotonin (Jones and others, 1968).
Carcinoid syndrome that occurs when tumors bronchus, has specific features, attacks redness differ by the severity of occurrence, often accompanied by fever, a watery eyes, runny nose, nausea and vomiting, hypotension, and by oliguria (Sandler, 1968). Such "carcinoid crises" (Kahil and others, 1964) can be caused by direct rapid flow of humoral agents in the arterial system, bypassing the portal circulation. "Syndrome redness" sometimes accompanied by hypertension, as well as diarrhea and asthma attacks.
Diarrhea in some cases combined with cramping pains in the abdomen, expressed rumbling. This symptom is caused by intestinal hyperperistaltic, caused by increased secretion of serotonin, and possibly bradikinina. Both of these agent increases tone smooth muscles bronchi, spazmiruet them that often leads to the atypical asthma attacks.
In addition to the "syndrome redness", when functioning carcinoid on the skin, it may cause changes otherwise.
Some patients have "phalaropodidae losses"associated with endogenous vitamin PP, due to the relative lack of tryptophan synthesis of nicotinic acid in the gut. Occurs hyperkeratosis, the skin becomes dry, scaly, formed grayish-black parts of pigmentation on the forearms and lower extremities, celebrated glossitis.
Along with "phalaropodidae lesions", may be a focal hyperpigmentation diffuse nature, caused by the excess deposition in the skin of products of destruction of serotonin. Skin metastases carcinoid sometimes painful.
In patients with carcinoid syndrome in 40-50% of cases are determined by the tricuspid valve insufficiency and pyloric stenosis of lung artery (Sjoerdsma, 1956). The pathogenesis of these lesions remains unclear, but most researchers are supporters of "biochemical theory" of their occurrence. The latter considers the defeat of the endocardium (mainly proliferative and not inflammatory nature) with carcinoid syndrome as a result hypersecretion of serotonin and other biologically active substances, which primarily affect the endocardium and contribute to excessive growth of connective tissue.
Serotonin clearly raises a tone of blood vessels of the lungs (Page, 1958), which creates additional workload of the right ventricle. Early last hypertrophies, and then quickly comes to his myogenic dilation with symptoms of stagnation in a large circle circulation.
The origin of edema with carcinoid syndrome, in addition to the hemodynamic factors involved hypoalbuminemia, due to lack of tryptophan for protein synthesis, as well as the systematic increase of venous pressure in the midst of the attacks "redness". The role and antidiuretic effect of serotonin, and some patients increased concentration of antidiuretic hormone.
Patients, long-suffering carcinoid syndrome, exhausted, in some cases, the weight is preserved.
Sometimes there are sudden dizziness, transient visual disturbances caused cerebral hypoxia.