Endocrine Abstracts

Background: We have seen an increasing number of carcinoid flare events following PRRT which is a recognised complication of medical/ surgical intervention. Flare events are less severe than carcinoid crisis but require prompt management to avoid patient morbidity and mortality. The rise in this complication is likely due to the complexity and advanced stage of disease at time of therapy commencement. There is very little in the literature about management of this cohort of patients and to the authors’ knowledge, no universally accepted management algorithm. An additional and significant complicating factor in these patients is that they are radioactive.

Purpose: To create a management algorithm for patients who present with a carcinoid flare event during/ following PRRT.

Methods: We present a treatment algorithm for carcinoid flare events which also encompasses proactive treatment of high risk cases. We have had collaborative discussions with the critical care team to identify a suitable place for transfer in the event of acute deterioration to ensure both staff and patient safety. As this is an uncommon occurrence, regular study days have also been set up to ensure ongoing education of nursing staff and clinical technologists involved in radionuclide therapy.

Results: Since putting the protocol in place in November 2023, there have been two carcinoid flare events, neither of which required critical care input. These patients were subsequently able to complete all four treatment sessions with pre treatment optimisation and prophylactic short acting octreotide injections. Having a management algorithm has increased efficiency of treatment and confidence in the management of this entity. We would advocate this approach in an uncommon but serious complication of PRRT.