Warner R R, Mani S, Profeta J, Grunstein E
Mount Sinai School of Medicine, New York, NY.
Mt Sinai J Med. 1994 Sep;61(4):349-55.
In the severe crisis of carcinoid syndrome the flush is usually accompanied by hypotension and occasionally shock. Injection of octreotide, the long-acting analog of somatostatin, usually prevents or aborts this vasomotor reaction. A small minority of carcinoid syndrome patients manifest hypertension during their crises and little has been reported in the literature on their management. We present the first case reports of the response of patients with hypertensive carcinoid crisis to treatment with octreotide. The world literature contains reports of 20 prior cases of hypertensive carcinoid crises occurring in association with the stress of surgery and anesthesia. Review of these cases reveals no common feature, other than hypertension, that might clearly distinguish them from the typical hypotensive carcinoid syndrome patient. It is hypothesized that the mechanism of action of octreotide correcting the blood pressure changes in all carcinoid crises is via its known inhibition of vasomotor product release from the tumor and blocking receptors for these substances. We suggest that hypertensive as well as hypotensive carcinoid crises respond to octreotide and that this agent should be considered for prophylactic and emergency use in all carcinoid syndrome patients prior to and during anesthesia and surgery.
在类癌综合征的严重危机中，潮红通常伴有低血压，偶尔还会出现休克。注射奥曲肽（一种长效生长抑素类似物）通常可预防或中止这种血管运动反应。少数类癌综合征患者在危机期间表现为高血压，而关于其治疗的文献报道很少。我们首次报告了高血压类癌危象患者对奥曲肽治疗的反应。世界文献中有20例先前报道的高血压类癌危象病例，这些病例与手术和麻醉应激有关。对这些病例的回顾显示，除了高血压外，没有其他共同特征可以将它们与典型的低血压类癌综合征患者明显区分开来。据推测，奥曲肽纠正所有类癌危象中血压变化的作用机制是通过其已知的抑制肿瘤释放血管运动产物并阻断这些物质的受体。我们建议，高血压和低血压类癌危象均对奥曲肽有反应，并且在麻醉和手术前及手术期间，应考虑将该药物用于所有类癌综合征患者的预防和急救。
