Exploring the carcinoid crisis: insights from a cancer-specific centre

Del Olmo-Garc&#237;a, M; Kong, G; Wong, H; Michael, M; Ismail, H; Nip, WF; Pasanen, L; Chiang, C

Author(s): Del Olmo-García, M; Kong, G; Wong, H; Michael, M; Ismail, H; Nip, WF; Pasanen, L; Chiang, C;
Details: Publication Year 2025-01,Volume 5,Issue #1,Page e250034
Journal Title: Endocrine Oncology
Publication Type: Research article
Abstract: OBJECTIVE: To assess the prevalence, pre-procedure biomarkers, and management of carcinoid crisis (CC) in a cancer-specific hospital. DESIGN: Retrospective observational study of subjects with carcinoid syndrome (CS) undergoing invasive procedures or systemic therapies over 5 years. METHODS: Electronic haemodynamic parameters and patient records were extracted. CC incidence was assessed using strict (SBP <80 mmHg, >10 min) or broad criteria (severe hypotension, hypertension, arrhythmias, >1 min). RESULTS: 48 patients with CS underwent 71 procedures (35 invasive procedures, 36 systemic therapies). CC did not occur during systemic therapies. Prophylactic octreotide infusion was used in 63% of invasive procedures. CC occurred in 43% of procedures as defined by broad criteria and in 20% as defined by strict criteria. Compared to those without CC, patients with strictly defined CC had higher chromogranin A (P < 0.001), higher 5-HIAA (P = 0.03), higher BNP (P = 0.03), longer hospital stay (P < 0.001), and higher postoperative complications (P < 0.001). Lower intraoperative mean arterial pressure (MAP) correlated with postoperative complications (ρ = -0.55, P = 0.004) and longer hospital stay (ρ = -0.62, P = 0.001). All subjects with strictly defined CC were treated with more than one drug; however, there were five patients with broadly defined CC who did not require treatment for transient haemodynamic instability. CONCLUSIONS: Pre-operative biomarker assessment is essential to triage CS patients at risk of CC and thereafter trigger a risk-based management pathway. Prolonged intraoperative hypotension correlated best with postoperative outcomes, and is a better definition for CC in our cohort.
Publisher: Bioscientifica
Keywords: carcinoid; carcinoid crisis; neuroendocrine tumour; somatostatin analogues
Department(s): Cancer Imaging; Medical Oncology; Anaesthetics; Internal Medicine
Publisher's Version: https://doi.org/10.1530/eo-25-0034
Open Access at Publisher's Site: https://doi.org/10.1530/eo-25-0034
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2026-01-13 04:29:42

Last Modified: 2026-01-13 04:29:53