sfk
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45 yr old male presents with diarrhea, flushing pruritis and wieght loss. Urinary HIAA is elevated. Whic is the most likely site of patients tumour?
Stomach
Small bowel
Appendix
Rectum
Lung
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| paheli
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Lung
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| yogesh
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Lung. GI carcinoids are not symptomatic before they metastasize.(because 5HT is metabolized in liver) Primary bronchial/pulmo. carcinoids gives carcinoid syndrome.
Am I right sfk?
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| Eagle_303
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Who says it has not metastasized in the liver ?
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| inkspot
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this is not a full case history ! just pointers attached together
well the MCC is appendix but it does not metastatize due to small size
MCC that causes carcinoid is : small bowel ( my answer) it requires mets to liver , although not mentioned in question stem
lung carcinoid does not need mets .
another interesting association:
GI carcinoid involve RT side of heart
Lung carcinoid involve LT side of heart
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| sfk
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The answer is small bowel. 
From what i know, appendiceal carcinoids are most common, but symptomatic only if metastasized. And lung carcinoids are less common, but more commonly symptomatic!!
So, most common cause of carcinoid syndrome should be lung, but in this case is it the weight loss which probably points towards a metastasis?
Even then is carcinoid of appendix more common than that in the small bowel.
HEAPS OF CONFUSION!!!!!!
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| Eagle_303
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These isolated systemic symptoms are NOT A FEATURE OF lung carcinoid. Most commonly local symptoms must be present like cough ,hemoptysis ,bronchial wheez. bronchial obstruction etc.
"
About 25% of patients with pulmonary carcinoid tumors are asymptomatic at the time of discovery.
In symptomatic patients, the most common clinical findings are those associated with bronchial obstruction, such as persistent cough, hemoptysis, and recurrent or obstructive pneumonitis. Wheezing, chest pain, and dyspnea also may be noted.
Although uncommon, various endocrine or neuroendocrine syndromes can be initial clinical manifestations of either typical or atypical pulmonary carcinoid tumors. Carcinoid syndrome, hypercortisolism and Cushing syndrome, inappropriate secretion of ADH, increased pigmentation secondary to excess MSH, and ectopic insulin production resulting in hypoglycemia are some of the endocrinopathies that can be produced by a pulmonary carcinoid tumor in a patient who is otherwise asymptomatic.
In cases of malignancy, the presence of metastatic disease can produce weight loss, weakness, and a general feeling of ill health. Carcinoid syndrome is observed most commonly when metastatic disease to the liver is present.
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| dramer
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LOOK HI
TODSY I READ THIS QUESTION IN UW and i stop in
i agree with u
the answer is small bowel in this patient
but if they ask u where the most common place for carcinoid tume the answer is appendix
lung is very rare but it give symtoms very earl if it is there fore it is not metastatic bcz it has been discoverd befor metastate
the answer in u r answer small bowell
but in general the most commn place is appendix
i hope that help u
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| sfk
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Agree with dramer and inkspot. Also went through various texts.
SO TO END ALL CONFUSION:
MC site for carcinoid-- Appendix
MC symptomatic carcinoids-- Small Bowel (ileum)
Bronchial carcinoids, rare, dont need to metastasize to produce symptoms.
Also, GI carcinoid involve Rt side of heart
Lung carcinoid involve Lt side of heart
Edited by sfk on 04/20/08 - 08:58 PM
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| paheli
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Thank you, gentlemen. I was wrong. 
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| yogesh
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sfk wrote:
Agree with dramer and inkspot. Also went through various texts.
SO TO END ALL CONFUSION:
MC site for carcinoid-- Appendix
MC symptomatic carcinoids-- Small Bowel (ileum)
Bronchial carcinoids, rare, need to metastasize to produce symptoms.
Also, GI carcinoid involve Rt side of heart
Lung carcinoid involve Lt side of heart
thanks sfk for clarification.
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| yogesh
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sfk wrote:
Agree with dramer and inkspot. Also went through various texts.
SO TO END ALL CONFUSION:
Bronchial carcinoids, rare, need to metastasize to produce symptoms.
Any mistake there??
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| sfk
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paheli wrote:
Thank you, gentlemen. .
(BTW, yogesh, good point!! corrected it)
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| yogesh
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sfk wrote:paheli wrote:
Thank you, gentlemen. .
(BTW, yogesh, good point!! corrected it)
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| Vietnamese
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Appendix (90%)
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| inkspot
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great!
also let me share a secret with you here: when ever the question says.
most likely ------ it means most common cause. before you start arguing with me. apply it to the questions that you do and you will understand that most likely mean actually most common and this is the reason why remembering most common cause ( etiology) in ranked order is so important.
there is a great thread on this forum called " most common " i recommend that one should go through it. step 2 is basically an exam of basic clinical and preventive medicine they are not interested if you know about the surgical correction methods of aortic disection. they are more interested that you should know that HTN needs to be corrected first before you do echo etc. also that a woman above 60 needs a DEXA scan for osteoporosis and LDL target for a patient with MI is less than 100. see these things are basic and the whole exam hovers around these basic little facts but for some reason we are more interested in difficult stuff which is not required. sorry my post was way off topic.
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| DrVirgo
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sfk wrote:
MC site for carcinoid-- Appendix
MC symptomatic carcinoids-- Small Bowel (ileum)
 Agree... If you ever see a question in which the patient is symptomatic ffrom a carcinoid, pick Ileum (small intestine)... As I remember the carcinoids in the appendix are too small to produce symptoms.
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| Vietnamese
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The question mentioned the SITE, not SYMPTOM.
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| DrVirgo
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Vietnamese wrote:
The question mentioned the SITE, not SYMPTOM.
To quote the question: "diarrhea, flushing pruritis and wieght loss" = Symptoms
Most likely site when there are symptoms like that is the small intestine (ileum).
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| peter90036
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Dr. Virgo: these tests require too much reading comprehension 
...also
please all you highly educated medical professionals
the word is P R U R i T U S
NOT p r u r i t i s
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| inkspot
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is it pronounced as pruritis or pruritus ? like ous or is ?
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| peter90036
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british pronounciation is like in the -itis, ex: sinusitis, dermatitis
yeah, american is like "ous", sero-us , or like fung-us, prurit-us, or just ..."itching"
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| DrVirgo
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What an interesting turn this thread has taken... going from discussing Carcinoid Syndrome to now correcting the spelling and contemplating the pronouncation of pruritis (with an i)
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| inkspot
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ohhh !
in US they call intestine as intesteeene !
besides heavy load of information we would be required to learn proper pronunciation to be like one of them !!!
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| peter90036
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look into my eyes... look into my eyes... you wanna be one of us,
say it with me... prurit-us .. prurit-us
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