A 63 year old male presented with chronic watery diarrhea associated with flushing charecterised by sudden onset deep red or violaceous erythema of the upper body often with pruritus, lacrimation and facial edema. The flushing was noticed to be precipitated by exercise, alcohol, stress and cheese intake. He has a history of wheezing and clinical examination revealed pellagra like skin lesion. All are useful steps in the treatment of this clinical condition, EXCEPT:
The clinical features in this case is suggestive of carcinoid syndrome. Serotonin receptor antagonists or somatostatin analogues are the drugs of choice to control diarrhea. Synthetic analogues of somatostatin (octreotide, lanreotide) are now the most widely used agents to control the symptoms of patients with carcinoid syndrome. Interferon alpha is repoed to be effective either alone or combined with hepatic aery embolization. Hepatic aery chemoembolization using (5-fluorouracil, doxorubicin, cisplatin, mitomycin) is effective in 60-75% of patients. Mammalian target of rapamycin (mTor) inhibitors (everolimus, rapamycin) are repoed to control the hypoglycemia in insulinoma. Ref: Harrisons Principles of Internal Medicine, 18th Edition, Page 3062-65
Lanreotide can be used to control the symptoms
Hepatic aery chemoembolization using doxorubicin is effective
Interferon Alpha can be effective in controlling the symptoms
Rapamycin is useful to control symptoms