Endocrine Abstracts

Introduction: Carcinoid crisis represents a rare medical emergency with potentially fatal manifestations that can occur in patients with neuroendocrine tumours (NETs). The condition is caused by a substantial release of vasoactive metabolites from the NETs during diagnostic or therapeutic interventions. However, in rare instances, it can occur spontaneously. Here, we report a patient who developed a carcinoid crisis following radioactive iodine¹³¹I (RAI) treatment for thyroid cancer.

Case report: A 72-year-old male known to have metastatic midgut NET with mediastinal and para-aortic lymphadenopathy and peritoneal disease, on long-acting somatostatin analogue therapy. He is also known to have metastatic follicular variant papillary thyroid cancer with lung nodules (pT3a NX M1 R1). The thyroid cancer was treated with thyroidectomy followed by ablative RAI¹³¹I treatment. The patient received two cycles of RAI¹³¹I treatment with no complications recorded. However, one week post receiving the third cycle, he developed clinical features of carcinoid crisis and presented with facial flushing, fever, wheezy chest, palpitations, and frequent watery diarrhoea up to 20 times per day. The patient was hyperthermic, tachycardic, hypotensive and had signs of bronchospasm. He was immediately resuscitated with intravenous fluid and commenced on intravenous Octreotide infusion as per the European Neuroendocrine Tumour Society guidelines. Rapid reversal of carcinoid crisis was achieved, and Octreotide infusion was gradually titrated down based on patient response. A complete biochemical and radiological assessment revealed no other potential precipitant of carcinoid crisis. The patient made a full recovery and was discharged.

Discussion: Early recognition and treatment of carcinoid crisis is imperative to avoid adverse consequences. Successful patient outcome greatly relies on the availability of clinical expertise and effective management. RAI might have induced carcinoid crisis in this patient; up to our knowledge, this has not been reported in the literature.