Carcinoid crisis induced by repeated abdominal examination

摘要

A 61-year-old man with metastatic carcinoid syndrome, including extensive liver involvement, was admitted acutely for investigation and management of increased lethargy, sweats and malaise. He had been receiving monthly somatostatin receptor analogue therapy (Lan-reotide Autogel 120 mg) for a period of 4 years, but prior to admission he had been referred for consideration of radionuclide therapy because of increasing hepatic enlargement and fatigue, indicative of disease progression. Chromogranin A drawn the day prior to admission was markedly elevated at 2880 U/L (reference range 0-21.8). Examination revealed facial flushing, jaundice, a soft ejection systolic murmur and massive hepatomegaly extending below the umbilicus. On admission, he had a raised white cell count and abnormal liver function tests. Septic screen, including blood and urine cultures, chest radiograph and abdominal ultrasound, was negative for an infective focus.