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Carcinoid Crisis Prevention — RACP Adult Medicine MCQ

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HardGeneral Internal MedicineCarcinoid Crisis PreventionRACP Adult Medicine

A 50-year-old with metastatic ileal neuroendocrine tumour has frequent flushing, wheeze and secretory diarrhoea despite short-acting rescue injections. Which preoperative intervention best reduces mediator symptoms before planned tumour surgery?

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Correct answer: D — Optimise somatostatin-analogue therapy and plan perioperative octreotide availability with the anaesthetic and neuroendocrine teams

The best answer is “Optimise somatostatin-analogue therapy and plan perioperative octreotide availability with the anaesthetic and neuroendocrine teams”. A somatostatin analogue is the principal pharmacological method for controlling carcinoid-syndrome mediator release; perioperative planning includes rescue octreotide and coordinated haemodynamic management. Prophylactic catecholamine, beta blockade or antihistamine monotherapy does not control the multiple vasoactive mediators. Stopping effective therapy can worsen symptoms. The exact infusion strategy is individualised because evidence for a universal regimen is limited.

Reference: eviQ: Neuroendocrine tumours: https://www.eviq.org.au/medical-oncology/upper-gastrointestinal/neuroendocrine