Luzzatto G, Pozza M, Cella G
Hôpital général de Padoue, Italie.
Presse Med. 1995 May 27;24(19):897-9.
The carcinoid syndrome is a rare clinical entity mainly characterized by flushing and diarrhoea. It is due to different biological mediators produced by tumours that arise from enterochromaffin cells. Such tumours are typically located in the ileum, have a long course and become symptomatic only in the presence of overt liver metastases. Among the involved mediators, the role of serotonin (5-hydroxytryptamine, 5-HT) has been ascertained in the pathogenesis of diarrhoea, while it remains controversial in that of flushing. Ketanserin is a 5HT-2 antagonist with no mixed receptor agonist-antagonist activity. We report the case of a severely distressing carcinoid syndrome fully dominated by ketanserin. The patient was a 75-year-old man, who came to our attention because of marked weight loss, impossibility to feed and almost continuous diarrhoea due to liver colonization of a mid ileum carcinoid tumour, previously resected at the age of 65. Sustained facial and trunk flushing also presented several times daily. Ketanserin, 20 mg twice a day orally, was administered and then increased up to 40 mg daily with no side effects and progressive complete control of both diarrhoea and flushing. It is suggested that ketanserin, due to its availability and tolerability, should first be considered for palliative relief of carcinoid syndrome. The literature on this subject is extensively reviewed.
类癌综合征是一种罕见的临床病症，主要特征为潮红和腹泻。它是由肠嗜铬细胞产生的不同生物介质所致。此类肿瘤通常位于回肠，病程较长，仅在出现明显肝转移时才会出现症状。在涉及的介质中，血清素（5-羟色胺，5-HT）在腹泻的发病机制中的作用已得到证实，而在潮红的发病机制中仍存在争议。酮色林是一种5HT-2拮抗剂，无混合受体激动剂-拮抗剂活性。我们报告了一例严重困扰的类癌综合征完全由酮色林控制的病例。患者为一名75岁男性，因显著体重减轻、无法进食以及因回肠中段类癌肿瘤肝转移导致的几乎持续腹泻前来就诊，该肿瘤此前在65岁时已切除。面部和躯干持续潮红每天也会出现数次。口服给予酮色林，每日2次，每次20mg，然后增至每日40mg，无副作用，腹泻和潮红逐渐完全得到控制。建议由于酮色林的可用性和耐受性，应首先考虑将其用于类癌综合征的姑息性缓解。本文对该主题的文献进行了广泛综述。
