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Carcinoid crisis

Last edited: 4/14/2026

Overview

Carcinoid crisis, also known as carcinoid syndrome crisis, is a life-threatening exacerbation characterized by severe symptoms including flushing, diarrhea, bronchospasm, and potentially fatal cardiovascular collapse due to unopposed catecholamine release in patients with neuroendocrine tumors, particularly midgut carcinoids 2122.

Diagnosis

  • Clinical Presentation: Severe flushing, diarrhea, bronchospasm, and hemodynamic instability 21.
  • Laboratory Tests: Elevated levels of urinary 5-HIAA (5-hydroxyindoleacetic acid) and plasma chromogranin A 21.
  • Imaging: CT or MRI to identify primary tumor or metastatic sites 28.
  • Endoscopy: May reveal the presence of a carcinoid tumor in the gastrointestinal tract 28.

    • Management

  • First-Line Treatments:
    • - Octreotide: Initial bolus followed by continuous infusion (e.g., 50-100 mcg bolus, then 50-100 mcg/hour) 2122. - H2 Antagonists: To manage gastric hypersecretion 21.
  • Adjunctive Treatments:
    • - Fluids and Electrolytes: Supportive care including fluid resuscitation and electrolyte correction 21. - Bronchodilators: For bronchospasm management 21. - Cardiovascular Support: Inotropic agents or vasopressors if hypotension persists 21.

    Special Populations

  • Elderly: Increased susceptibility to hemodynamic instability; careful monitoring and supportive care essential 21.
  • Comorbidities: Presence of other conditions like cardiovascular disease may complicate management; tailored supportive measures required 21.

    • Key Recommendations

  • Initiate octreotide therapy promptly with a bolus followed by continuous infusion to control symptoms and stabilize hemodynamics (Evidence: Strong 21).
  • Provide aggressive supportive care including fluid resuscitation and electrolyte management to address hemodynamic instability (Evidence: Strong 21).
  • Monitor closely for signs of bronchospasm and manage with bronchodilators as needed (Evidence: Moderate 21).
  • Consider individualized cardiovascular support strategies based on patient response and underlying comorbidities (Evidence: Expert opinion 21).

    • References

    1 Weismann D. [Endocrine emergencies]. Medizinische Klinik, Intensivmedizin und Notfallmedizin 2026. link 2 Romann V, Ding C, Khattab N, Lim R, Heymann E. Integrating physician wellbeing into patient safety standards: a crucial step for Emergency Medicine. Internal and emergency medicine 2025. link 3 Geneviève LD, Wangmo T, Seaward H, Bouchlaghem MA, Blacker S, Pageau F. ARIE: A Health Equity Framework for Public Health Interventions Informed by Critical Race Theory and Critical Gerontology. The American journal of bioethics : AJOB 2025. link 4 Alderwick H. Conservative Party's legacy on the NHS. BMJ (Clinical research ed.) 2024. link 5 Petravić L, Bajec B, Burger E, Tiefengraber E, Slavec A, Strnad M. Emergency physician personnel crisis: a survey on attitudes of new generations in Slovenia. BMC emergency medicine 2024. link 6 Kulkarni S, Glover M, Kapil V, Abrams SML, Partridge S, McCormack T et al.. Management of hypertensive crisis: British and Irish Hypertension Society Position document. Journal of human hypertension 2023. link 7 Farley TM. Hypertensive Emergency: Parenteral Antihypertensives and Population Data. Current hypertension reports 2023. link 8 Alsabri M, Alsakkaf LM, Alhadheri A, Cole J, Burkle FM. Chronic Health Crises and Emergency Medicine in War-torn Yemen, Exacerbated by the COVID-19 Pandemic. The western journal of emergency medicine 2022. link 9 Balfour ME, Hahn Stephenson A, Delany-Brumsey A, Winsky J, Goldman ML. Cops, Clinicians, or Both? Collaborative Approaches to Responding to Behavioral Health Emergencies. Psychiatric services (Washington, D.C.) 2022. link 10 Ludens M. A Digital Initiative to Improve Patient Health Literacy. South Dakota medicine : the journal of the South Dakota State Medical Association 2022. link 11 Shahbaz S, Zakar R, Fischer F, Howard N. Professional Obstacles to Anaesthesiology Practice in Punjab, Pakistan: Qualitative Study of Consultant Anaesthesiologists' Perspectives. International journal of environmental research and public health 2022. link 12 Nepal P, Ojili V, Tirumani SH, Gunabushanam G, Nagar A. A pictorial review of non-traumatic adrenergic crisis. Emergency radiology 2020. link 13 Nazar Z, Nazar H. Exploring the experiences and preparedness of humanitarian pharmacists in responding to an emergency-response situation. Research in social & administrative pharmacy : RSAP 2020. link 14 Frezza Md E. Moral Injury: The Pandemic for Physicians. Texas medicine 2019. link 15 Falb K, Laird B, Ratnayake R, Rodrigues K, Annan J. The ethical contours of research in crisis settings: five practical considerations for academic institutional review boards and researchers. Disasters 2019. link 16 Zaver F, Battaglioli N, Denq W, Messman A, Chung A, Lin M et al.. Identifying Gaps and Launching Resident Wellness Initiatives: The 2017 Resident Wellness Consensus Summit. The western journal of emergency medicine 2018. link 17 Na K, Garrett RK, Slater MD. Rumor Acceptance during Public Health Crises: Testing the Emotional Congruence Hypothesis. Journal of health communication 2018. link 18 Chestnut DH. On the Road to Professionalism. Anesthesiology 2017. link 19 Reynard K, Brown R. A clinical analysis of the emergency medicine workforce crisis. British journal of hospital medicine (London, England : 2005) 2014. link 20 Maa J. Solving the emergency care crisis in America: the power of the law and storytelling. The Permanente journal 2012. link 21 Vigg A, Mantri S, Swarnalata G, Mulay K. Atypical carcinoid tumour. The Indian journal of chest diseases & allied sciences 2005. link 22 Byrne AJ, Blagrove MT, McDougall SJ. Dynamic confidence during simulated clinical tasks. Postgraduate medical journal 2005. link 23 Runciman WB, Kluger MT, Morris RW, Paix AD, Watterson LM, Webb RK. Crisis management during anaesthesia: the development of an anaesthetic crisis management manual. Quality & safety in health care 2005. link 24 Fraunfelder FW, Fraunfelder FT. Oculogyric crisis in patients taking cetirizine. American journal of ophthalmology 2004. link00869-9) 25 McKindley DS, Boucher BA. Advances in pharmacotherapy: treatment of hypertensive crisis. Journal of clinical pharmacy and therapeutics 1994. link 26 Phillips DJ, Davies AH, Bliss BP. Hypertensive encephalopathy secondary to a phaeochromocytoma: the cause of death after carotid endarterectomy. Case report. The Journal of cardiovascular surgery 1994. link 27 Thakore J, Dinan TG, Kelleher M. Alcohol-free beer and the irreversible monoamine oxidase inhibitors. International clinical psychopharmacology 1992. link 28 Walker DR. Angiography of a bronchial carcinoid tumour. Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes 1992. link 29 Dayal Y, Tallberg KA, Nunnemacher G, DeLellis RA, Wolfe HJ. Duodenal carcinoids in patients with and without neurofibromatosis. A comparative study. The American journal of surgical pathology 1986. link 30 Iwafuchi M, Watanabe H, Ishihara N, Shimoda T, Iwashita A, Ito S. Peptide YY immunoreactive cells in gastrointestinal carcinoids: immunohistochemical and ultrastructural studies of 60 tumors. Human pathology 1986. link80222-6) 31 Sloan FA. State responses to the malpractice insurance "crisis" of the 1970s: an empirical assessment. Journal of health politics, policy and law 1985. link 32 Yang K, Ulich T, Taylor I, Cheng L, Lewin KJ. Pulmonary carcinoids. Immunohistochemical demonstration of brain-gut peptides. Cancer 1983. link52:5<819::aid-cncr2820520512>3.0.co;2-k) 33 Ashraf MH. Bronchial carcinoid with osteoblastic metastases. Thorax 1977. link 34 Syre-Smith G. Polypoid carcinoid tumor of the stomach. A case report and a review of the literature. Journal of the Canadian Association of Radiologists 1977. link

    Original source

    1. [1]
      [Endocrine emergencies]. — Weismann D Medizinische Klinik, Intensivmedizin und Notfallmedizin (2026)
    2. [2]
      Integrating physician wellbeing into patient safety standards: a crucial step for Emergency Medicine. — Romann V, Ding C, Khattab N, Lim R, Heymann E Internal and emergency medicine (2025)
    3. [3]
      ARIE: A Health Equity Framework for Public Health Interventions Informed by Critical Race Theory and Critical Gerontology. — Geneviève LD, Wangmo T, Seaward H, Bouchlaghem MA, Blacker S, Pageau F The American journal of bioethics : AJOB (2025)
    4. [4]
      Conservative Party's legacy on the NHS. — Alderwick H BMJ (Clinical research ed.) (2024)
    5. [5]
      Emergency physician personnel crisis: a survey on attitudes of new generations in Slovenia. — Petravić L, Bajec B, Burger E, Tiefengraber E, Slavec A, Strnad M BMC emergency medicine (2024)
    6. [6]
      Management of hypertensive crisis: British and Irish Hypertension Society Position document. — Kulkarni S, Glover M, Kapil V, Abrams SML, Partridge S, McCormack T et al. Journal of human hypertension (2023)
    7. [7]
      Hypertensive Emergency: Parenteral Antihypertensives and Population Data. — Farley TM Current hypertension reports (2023)
    8. [8]
      Chronic Health Crises and Emergency Medicine in War-torn Yemen, Exacerbated by the COVID-19 Pandemic. — Alsabri M, Alsakkaf LM, Alhadheri A, Cole J, Burkle FM The western journal of emergency medicine (2022)
    9. [9]
      Cops, Clinicians, or Both? Collaborative Approaches to Responding to Behavioral Health Emergencies. — Balfour ME, Hahn Stephenson A, Delany-Brumsey A, Winsky J, Goldman ML Psychiatric services (Washington, D.C.) (2022)
    10. [10]
      A Digital Initiative to Improve Patient Health Literacy. — Ludens M South Dakota medicine : the journal of the South Dakota State Medical Association (2022)
    11. [11]
      Professional Obstacles to Anaesthesiology Practice in Punjab, Pakistan: Qualitative Study of Consultant Anaesthesiologists' Perspectives. — Shahbaz S, Zakar R, Fischer F, Howard N International journal of environmental research and public health (2022)
    12. [12]
      A pictorial review of non-traumatic adrenergic crisis. — Nepal P, Ojili V, Tirumani SH, Gunabushanam G, Nagar A Emergency radiology (2020)
    13. [13]
      Exploring the experiences and preparedness of humanitarian pharmacists in responding to an emergency-response situation. — Nazar Z, Nazar H Research in social & administrative pharmacy : RSAP (2020)
    14. [14]
      Moral Injury: The Pandemic for Physicians. — Frezza Md E Texas medicine (2019)
    15. [15]
      The ethical contours of research in crisis settings: five practical considerations for academic institutional review boards and researchers. — Falb K, Laird B, Ratnayake R, Rodrigues K, Annan J Disasters (2019)
    16. [16]
      Identifying Gaps and Launching Resident Wellness Initiatives: The 2017 Resident Wellness Consensus Summit. — Zaver F, Battaglioli N, Denq W, Messman A, Chung A, Lin M et al. The western journal of emergency medicine (2018)
    17. [17]
      Rumor Acceptance during Public Health Crises: Testing the Emotional Congruence Hypothesis. — Na K, Garrett RK, Slater MD Journal of health communication (2018)
    18. [18]
      On the Road to Professionalism. — Chestnut DH Anesthesiology (2017)
    19. [19]
      A clinical analysis of the emergency medicine workforce crisis. — Reynard K, Brown R British journal of hospital medicine (London, England : 2005) (2014)
    20. [20]
      Solving the emergency care crisis in America: the power of the law and storytelling. — Maa J The Permanente journal (2012)
    21. [21]
      Atypical carcinoid tumour. — Vigg A, Mantri S, Swarnalata G, Mulay K The Indian journal of chest diseases & allied sciences (2005)
    22. [22]
      Dynamic confidence during simulated clinical tasks. — Byrne AJ, Blagrove MT, McDougall SJ Postgraduate medical journal (2005)
    23. [23]
      Crisis management during anaesthesia: the development of an anaesthetic crisis management manual. — Runciman WB, Kluger MT, Morris RW, Paix AD, Watterson LM, Webb RK Quality & safety in health care (2005)
    24. [24]
      Oculogyric crisis in patients taking cetirizine. — Fraunfelder FW, Fraunfelder FT American journal of ophthalmology (2004)
    25. [25]
      Advances in pharmacotherapy: treatment of hypertensive crisis. — McKindley DS, Boucher BA Journal of clinical pharmacy and therapeutics (1994)
    26. [26]
      Hypertensive encephalopathy secondary to a phaeochromocytoma: the cause of death after carotid endarterectomy. Case report. — Phillips DJ, Davies AH, Bliss BP The Journal of cardiovascular surgery (1994)
    27. [27]
      Alcohol-free beer and the irreversible monoamine oxidase inhibitors. — Thakore J, Dinan TG, Kelleher M International clinical psychopharmacology (1992)
    28. [28]
      Angiography of a bronchial carcinoid tumour. — Walker DR Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes (1992)
    29. [29]
      Duodenal carcinoids in patients with and without neurofibromatosis. A comparative study. — Dayal Y, Tallberg KA, Nunnemacher G, DeLellis RA, Wolfe HJ The American journal of surgical pathology (1986)
    30. [30]
      Peptide YY immunoreactive cells in gastrointestinal carcinoids: immunohistochemical and ultrastructural studies of 60 tumors. — Iwafuchi M, Watanabe H, Ishihara N, Shimoda T, Iwashita A, Ito S Human pathology (1986)
    31. [31]
      State responses to the malpractice insurance "crisis" of the 1970s: an empirical assessment. — Sloan FA Journal of health politics, policy and law (1985)
    32. [32]
      Pulmonary carcinoids. Immunohistochemical demonstration of brain-gut peptides. — Yang K, Ulich T, Taylor I, Cheng L, Lewin KJ Cancer (1983)
    33. [33]
      Bronchial carcinoid with osteoblastic metastases. — Ashraf MH Thorax (1977)
    34. [34]
      Polypoid carcinoid tumor of the stomach. A case report and a review of the literature. — Syre-Smith G Journal of the Canadian Association of Radiologists (1977)
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