Carcinoid syndrome
ICD-10 E34.0 · ICD-11 5B10

Treatment of Carcinoid Syndrome with Severe Flushing and Haemodynamic Instability

Clinical Scenario

This protocol addresses the most critical presentation of carcinoid syndrome: a florid crisis characterised by abrupt, severe flushing alongside profound haemodynamic instability — including both hypertension and hypotension — profuse diarrhoea, distressing bronchospasm with wheezing, severe labial and periocular oedema, and, at its extreme, frank shock.

Key Features of This Presentation

The scenario is defined by the convergence of multiple severe manifestations occurring together:

Severe flushing Haemodynamic instability Hypertension / hypotension Labial & periocular oedema Profuse diarrhoea Bronchospasm / wheezing Shock

This multi-system crisis requires prompt recognition and aggressive management to restore stability.

Treatment Approach — Overview

Management involves intravenous octreotide as the central intervention, combined with targeted supportive measures including intravenous fluids, corticosteroids, and carefully selected vasopressors. The specific agents, sequencing, and clinical decision points are detailed in the full structured regimen.

Clinical Goal

Restoration of haemodynamic and clinical stability.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1111/jne.13146

Severe flushing, hypertension/hypotension, severe labial and periocular oedema, severe diarrhoea, shock.

It is defined by abrupt flushing, severe shifts in blood pressure with haemodynamic instability, profuse diarrhoea, and distressing bronchospasm with wheezing (Table 3).

Octreotide i.v. (bolus and continuous infusion), i.v. fluids, corticosteroids, vasopressors.

Despite prophylactic measures, carcinoid crisis is not entirely preventable and requires prompt recognition intraoperatively and aggressive treatment including intravenous fluids, corticosteroids, and vasopressors.

However, if a CS patient needs to be on sympathomimetics (e.g., patients in an intensive care unit on hypovolemic or septic shock), a simultaneous i.v. octreotide infusion to prevent carcinoid crisis is recommended and the selective alpha1-agonist phenylephrine and vasopressin are the preferred vasopressors in this context.

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