Bronchial Adenoma And The Carcinoid Syndrome

Abstract

The carcinoid syndrome includes symptoms and signs associated with elevated levels of tryptophan metabolites and 1 or several biologically active peptides. Primary carcinoid tumors usually occur in the bowel, but may develop in other sites including the bronchus. Although approximately 85% of bronchial adenomas are of the carcinoid type, only a small number are endocrine-functioning. Treatment of the carcinoid syndrome is palliative, but suitable measures lessen symptoms for months or years. If hepatic metastases are accessible to excision, surgical removal should be attempted. Because patients usually are sensitive to anesthetic agents, appropriate precautions must be taken in the choice of drugs and in the administration of anesthesia. When surgical treatment is not possible, chemotherapy should be considered. Objective tumor response has been reported with intravenous cyclophosphamide and intra-arterial (hepatic) 5-flourouracil. Metabolic antagonists have provided varied results. Chlorpromazine, which might act as a bradykinin inhibitor, has been of use symptomatically. Adrenocortical hormones should be tried in patients with marked flushing, fever, and rapid deterioration. Irradiation therapy has produced variable results and is not the treatment of choice.