69-year-old male with background of hypertension and dyslipidaemia was admitted to ENT with a food bolus obstruction. CXR on admission revealed a well-defined mass in the right lower lobe consistent with lung cancer. Oesophagoscopy revealed a narrowing level secondary to external compression. A staging CT of chest and abdomen confirmed a mass on the right base invading the main right lower lobe bronchus. Incidentally there was an 8 cm infra renal abdominal aortic aneurysm. The patient was referred to the chest physicians who undertook a bronchoscopy, which confirmed a tumour occluding the right lower lobe bronchus. Histology confirmed that this was a neuroendocrine tumour. It was decided to proceed with abdominal aortic aneurysm repair before chest surgery and the patient was referred to the vascular surgeons. It was only at pre-operative assessment with the anaesthetist that symptoms of intermittent flushing and diarrhoea were elicited. The patient was then urgently referred for an endocrinology review. Urinary 5HIAA and Chromogranin A were elevated. The patient was started on S/c Octreotide 50 mcg TDS with partial relief of symptoms. The dose was increased to 100 mcg TDS and symptoms were abolished. He then underwent AAA repair with IV octreotide infusion peri-operatively for 24 hours. S/c octreotide was recommenced and he later underwent lobectomy again with IV with Octreotide cover. Histology confirmed bronchial carcinoid. Octreotide was stopped immediately post operatively. At out-patient follow up 3 weeks later the patient was well with no symptoms of flushing or diarrhoea. 24 hour urinary collections were normal.
This case confirms how peri-operative Octreotide can be used effectively and safely can be used in patients with carcinoid tumours to manage symptoms and to avoid precipitating a carcinoid crisis.