Carcinoid Crisis — SCE Medical Oncology MCQ

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ModerateOncological EmergenciesCarcinoid CrisisSCE Medical Oncology

A 45-year-old man with metastatic midgut carcinoid tumour develops flushing, watery diarrhoea and bronchospasm during a surgical procedure (liver biopsy under sedation). His blood pressure drops to 75/45 mmHg. What is the immediate treatment?

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Correct answer: D — IV octreotide

Carcinoid crisis is a life-threatening complication caused by massive serotonin release from tumour manipulation (surgery, biopsy, anaesthesia). The immediate treatment is IV octreotide (bolus 100-500 mcg then infusion). Pre-procedural octreotide prophylaxis should have been given. Adrenaline and sympathomimetics should be avoided or used with extreme caution as they may paradoxically worsen the crisis by stimulating further hormone release. IV fluids are supportive. Antihistamines alone are insufficient.

Reference: ESMO 2024 NET Clinical Practice Guidelines; Kinney et al Anaesthesia 2001