A case of Carcinoid Crisis Despite High Dose Somatostatin Analogue Therapy Peri-operatively

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Introduction: Carcinoid crisis is a life threatening endocrine emergency. Somatostatin analogues (SSA) are recommended as prophylactic administration before invasive procedures. It remains unclear whether there is an optimal dose of prophylactic somatostatin analogue therapy in the peri-operative period.

Aim(s): A 62 year old female, newly diagnosed with metastatic well-differentiated midgut neuroendocrine tumour and carcinoid syndrome, was admitted for a right hemicolectomy. She had an elevated urinary 5-HIAA of 1327umol/24h (NR 0-50). In light of the biochemical findings, octreotide (500 mcg IV) was administered two hours before surgery, then continuously infused (500 mcg/hr). Intraoperative mobilisation of the bowel caused acute hypercapnia, hypotension and a PEA arrest ensued. Hydrocortisone (400 mg IV) and octreotide (100 mcg IV) were administered after adrenaline (1mg IV). Clinically, the patient was flushed with a wide spread maculopapular rash at the time of the arrest. She responded to additional adrenaline, anti-histamine and octreotide (500mcg/hr). The surgical team decided to continue with the hemicolectomy and ileostomy due to the risk of further cardiovascular instability if a re-laparotomy was to be performed and the clinical concern of imminent bowel obstruction. Post-operatively, the patient was admitted to ITU for 2 days. She has since made a full recovery. She continues on lanreotide (120mg s/c every 21 days).

Materials and methods: NA

Conference: 15th Annual ENETSConcerence (2018)

Presenting Author:

Authors: Pitfield D, Casey R, Seetho I, Shaw A, Buscombe J,

Keywords: carcinoid syndrome, carcinoid crisis, octreotide, surgery,