A 62-year-old man comes to the office due to watery diarrhea. He has also been having episodes of dyspnea and wheezing. His wife has noticed that he sometimes becomes very flushed and red. The patient has no abdominal pain, vomiting, cough, or fever. He has a history of hypertension and takes amlodipine. He does not use tobacco, alcohol, or illicit drugs. His blood pressure is 140/70 mm Hg and pulse is 82/min. Cardiopulmonary examination is unremarkable. The abdomen is soft and nontender. Chest x-ray is normal, and the abdominal CT scan reveals mass lesions in the right liver lobe and ileum. Surgery is scheduled to resect the tumors. Which of the following medications can be used to relieve this patient's symptoms prior to surgery?

Question

A 62-year-old man comes to the office due to watery diarrhea.  He has also been having episodes of dyspnea and wheezing.  His wife has noticed that he sometimes becomes very flushed and red.  The patient has no abdominal pain, vomiting, cough, or fever.  He has a history of hypertension and takes amlodipine.  He does not use tobacco, alcohol, or illicit drugs.  His blood pressure is 140/70 mm Hg and pulse is 82/min.  Cardiopulmonary examination is unremarkable.  The abdomen is soft and nontender.  Chest x-ray is normal, and the abdominal CT scan reveals mass lesions in the right liver lobe and ileum.  Surgery is scheduled to resect the tumors.  Which of the following medications can be used to relieve this patient's symptoms prior to surgery?

Quizplus · Accepted Answer

11ec160b_3bca_cbbc_9249_21234bfe55d4_MD0001_00 The combination of wheezing, diarrhea, and facial flushing in association with an ileal tumor with hepatic metastasis is suggestive of carcinoid syndrome. Carcinoid tumors (most common ileal tumors) secrete a number of biologically active substances including serotonin and can cause symptoms when they metastasize. Common manifestations of carcinoid syndrome include flushing, asthma-like symptoms (wheezing, dyspnea), diarrhea, and syncope (due to low blood pressure). Long-standing carcinoid syndrome can cause right-sided valvular heart disease. The most definitive treatment for carcinoid syndrome is surgical excision. Medical therapy with octreotide can be used to control symptoms. Octreotide is a synthetic analog of somatostatin with a longer half-life. It acts on somatostatin receptors and inhibits secretion of many hormones and hormone-like substances. Octreotide is also used to inhibit secretory diarrhea in VIPomas (pancreatic endocrine tumors). (Choice A) Cabergoline is a dopamine agonist used in growth hormone-secreting pituitary tumors or prolactinoma. (Choice B) Leuprolide is a synthetic analog of gonadotropin-releasing hormone (GnRH). Continuous administration suppresses release of LH and FSH. Leuprolide is used in management of prostatic cancer, precocious puberty, and endometriosis. (Choice D) Phenoxybenzamine is an alpha blocker that is used in treatment of pheochromocytoma. (Choice E) Rituximab is a CD20 monoclonal antibody used to treat multiple myeloma, leukemia, and multiple autoimmune disorders. Educational objective: Carcinoid syndrome may accompany extraintestinal metastases of gastrointestinal carcinoid tumors. Octreotide is a synthetic somatostatin analog used to control the symptoms of carcinoid syndrome. __________ References: Small bowel cancer in the United States: changes in epidemiology, treatment, and survival over the last 20 years. (http://www.ncbi.nlm.nih.gov/pubmed/19106677)

A 62-Year-Old Man Comes to the Office Due to Watery