Differentiating carcinoid syndrome from other diseases: Difference between revisions

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! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
! colspan="2" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
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| colspan="9" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
| colspan="9" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
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! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
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| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
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! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diarrhea
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diarrhea
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* Transthoracic echocardiography
* Transthoracic echocardiography
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Carcinoid Syndrome<ref name="pmid30133565">{{cite journal |vauthors=Rubin de Celis Ferrari AC, Glasberg J, Riechelmann RP |title=Carcinoid syndrome: update on the pathophysiology and treatment |journal=Clinics (Sao Paulo) |volume=73 |issue=suppl 1 |pages=e490s |date=August 2018 |pmid=30133565 |pmc=6096975 |doi=10.6061/clinics/2018/e490s |url=}}</ref><ref name="pmid14693013">{{cite journal |vauthors=Hegyi J, Schwartz RA, Hegyi V |title=Pellagra: dermatitis, dementia, and diarrhea |journal=Int. J. Dermatol. |volume=43 |issue=1 |pages=1–5 |date=January 2004 |pmid=14693013 |doi= |url=}}</ref><ref name="pmid15100502">{{cite journal |vauthors=Savelli G, Lucignani G, Seregni E, Marchianò A, Serafini G, Aliberti G, Villano C, Maccauro M, Bombardieri E |title=Feasibility of somatostatin receptor scintigraphy in the detection of occult primary gastro-entero-pancreatic (GEP) neuroendocrine tumours |journal=Nucl Med Commun |volume=25 |issue=5 |pages=445–9 |date=May 2004 |pmid=15100502 |doi= |url=}}</ref><ref name="pmid151005022">{{cite journal |vauthors=Savelli G, Lucignani G, Seregni E, Marchianò A, Serafini G, Aliberti G, Villano C, Maccauro M, Bombardieri E |title=Feasibility of somatostatin receptor scintigraphy in the detection of occult primary gastro-entero-pancreatic (GEP) neuroendocrine tumours |journal=Nucl Med Commun |volume=25 |issue=5 |pages=445–9 |date=May 2004 |pmid=15100502 |doi= |url=}}</ref>
| rowspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |Carcinoid Syndrome<ref name="pmid30133565">{{cite journal |vauthors=Rubin de Celis Ferrari AC, Glasberg J, Riechelmann RP |title=Carcinoid syndrome: update on the pathophysiology and treatment |journal=Clinics (Sao Paulo) |volume=73 |issue=suppl 1 |pages=e490s |date=August 2018 |pmid=30133565 |pmc=6096975 |doi=10.6061/clinics/2018/e490s |url=}}</ref><ref name="pmid14693013">{{cite journal |vauthors=Hegyi J, Schwartz RA, Hegyi V |title=Pellagra: dermatitis, dementia, and diarrhea |journal=Int. J. Dermatol. |volume=43 |issue=1 |pages=1–5 |date=January 2004 |pmid=14693013 |doi= |url=}}</ref><ref name="pmid15100502">{{cite journal |vauthors=Savelli G, Lucignani G, Seregni E, Marchianò A, Serafini G, Aliberti G, Villano C, Maccauro M, Bombardieri E |title=Feasibility of somatostatin receptor scintigraphy in the detection of occult primary gastro-entero-pancreatic (GEP) neuroendocrine tumours |journal=Nucl Med Commun |volume=25 |issue=5 |pages=445–9 |date=May 2004 |pmid=15100502 |doi= |url=}}</ref><ref name="pmid151005022">{{cite journal |vauthors=Savelli G, Lucignani G, Seregni E, Marchianò A, Serafini G, Aliberti G, Villano C, Maccauro M, Bombardieri E |title=Feasibility of somatostatin receptor scintigraphy in the detection of occult primary gastro-entero-pancreatic (GEP) neuroendocrine tumours |journal=Nucl Med Commun |volume=25 |issue=5 |pages=445–9 |date=May 2004 |pmid=15100502 |doi= |url=}}</ref>
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Pathognomonic radiological sign of midgut NET.
Pathognomonic radiological sign of midgut NET.
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Irritable Bowel Syndrome
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| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |Irritable Bowel Syndrome
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Systemic mastocytosis
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |Systemic mastocytosis
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|Malignant neoplasms of small intestine
| colspan="2" |Malignant neoplasms of small intestine
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|Benign cutaneous flushing
| colspan="2" |Benign cutaneous flushing
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|Recurrent idiopathic anaphylaxis
| colspan="2" |Recurrent idiopathic anaphylaxis
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Crohn disease
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |Crohn disease
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* Right lower quadrant pain
* Right lower quadrant pain
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Asthma exacerbation  
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |Asthma exacerbation  
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Acute Urticaria
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |Acute Urticaria
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|Anaphylaxis
| colspan="2" |Anaphylaxis
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Revision as of 18:11, 12 February 2019

Carcinoid syndrome Microchapters

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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:[1]

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 Other physical findings 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 Other diagnostic studies
  • Transthoracic echocardiography
Carcinoid Syndrome[2][3][4][5] +

Mild

+
  • Intermittent
  • Secretory type
 + + +
  • Pellagra

Dermatitis

Diarrhea

Dementia

+ + + + + +
  • NT-proBNP
    • Screening of carcinoid heart disease
    • Blood Serotonin levels
 +
  • Localization of carcinoid tumor
  • Positron emission tomography-computed tomography (PET-CT) using 18-fluoro-dihydroxyphenylalanine
  • Ki-67 labeling index
  • Valve thickening with retraction and reduction in the mobility of the tricuspid valve
  • Somatostatin receptor scintigraphy [SRS], or Octreoscan
  • Mesenteric fibrosis

Pathognomonic radiological sign of midgut NET.

Irritable Bowel Syndrome
  • Intermittent
  • Chronic history
 - -
Systemic mastocytosis -
Malignant neoplasms of small intestine
Benign cutaneous flushing
Recurrent idiopathic anaphylaxis
Crohn disease
  • Right lower quadrant pain
 +/- - - -
  • oral lesions
  • Perianal lesions
 - -
  • CRP may be high
 Endoscopy
Asthma exacerbation - - - + + + - - + - - - Chest X ray
Acute Urticaria
Anaphylaxis
Angioedema
Drugs causing flushing
  • Nicotinic acid
  • Levodopa
  • Bromocriptine
  • Diltiazem
Medullary Thyroid Carcinoma

References

  1. ↑ Metcalfe DD (2000). "Differential diagnosis of the patient with unexplained flushing/anaphylaxis". Allergy Asthma Proc. 21 (1): 21–4. PMID 10748948.
  2. ↑ Rubin de Celis Ferrari AC, Glasberg J, Riechelmann RP (August 2018). "Carcinoid syndrome: update on the pathophysiology and treatment". Clinics (Sao Paulo). 73 (suppl 1): e490s. doi:10.6061/clinics/2018/e490s. PMC 6096975. PMID 30133565.
  3. ↑ Hegyi J, Schwartz RA, Hegyi V (January 2004). "Pellagra: dermatitis, dementia, and diarrhea". Int. J. Dermatol. 43 (1): 1–5. PMID 14693013.
  4. ↑ Savelli G, Lucignani G, Seregni E, Marchianò A, Serafini G, Aliberti G, Villano C, Maccauro M, Bombardieri E (May 2004). "Feasibility of somatostatin receptor scintigraphy in the detection of occult primary gastro-entero-pancreatic (GEP) neuroendocrine tumours". Nucl Med Commun. 25 (5): 445–9. PMID 15100502.
  5. ↑ Savelli G, Lucignani G, Seregni E, Marchianò A, Serafini G, Aliberti G, Villano C, Maccauro M, Bombardieri E (May 2004). "Feasibility of somatostatin receptor scintigraphy in the detection of occult primary gastro-entero-pancreatic (GEP) neuroendocrine tumours". Nucl Med Commun. 25 (5): 445–9. PMID 15100502.

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