Differentiating carcinoid syndrome from other diseases

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]

Overview

Carcinoid syndrome must be differentiated from systemic mastocytosis, medullary thyroid carcinoma, irritable bowel syndrome, malignant neoplasms of the small intestine, benign cutaneous flushing, and recurrent idiopathic anaphylaxis.

Differentiating Carcinoid Syndrome from other Diseases

Carcinoid syndrome must be differentiated from:

• Systemic mastocytosis
• Medullary thyroid carcinoma
• Irritable bowel syndrome
• Malignant neoplasms of the small intestine
• Benign cutaneous flushing
• Recurrent idiopathic anaphylaxis

On the basis [symptom 1], [symptom 2], and [symptom 3], [disease name] must be differentiated from [disease 1], [disease 2], [disease 3], [disease 4], [disease 5], and [disease 6].

Diseases		Clinical manifestations											Para-clinical findings									Gold standard	Additional findings
		Symptoms						Physical examination
													Lab Findings			Imaging					Histopathology
		Abdominal pain	Diarrhea	Flushing	Dyspnea	Palpitations	Other symptoms	Wheezing	Telangiectasia	Hypotension	Tachycardia	Systolic murmur of tricuspid regurgitation	Urinary 5-hydroxyindoleacetic acid (5-HIAA)	Serum Chromogranin A (CgA)	Other markers	Abdominal computed tomography (CT)	MRI	Somatostatin receptor scintigraphy [SRS], or Octreoscan	Metaiodobenzylguanidine (MIBG) scintigraphy	Transthoracic chocardiography
Carcinoid Syndrome		+ Mild	+ Intermittent Secretory type	+	+	+	Pellagra Dermatitis Diarrhea Dementia	+	+	+	+		+	+	NT-proBNP Screening of carcinoid heart disease Blood Serotonin levels			+ Localization of carcinoid tumor		Valve thickening with retraction and reduction in the mobility of the tricuspid valve			Mesenteric fibrosis Pathognomonic radiological sign of midgut NET.
Irritable Bowel Syndrome													-	-
Systemic mastocytosis													-
Malignant neoplasms of small intestine
Benign cutaneous flushing
Recurrent idiopathic anaphylaxis
Crohn disease													-	-
Asthma exacerbation													-	-
Acute Urticaria
Anaphylaxis
Angioedema
Drugs causing flushing																							Nicotinic acid Levodopa Bromocriptine Diltiazem