Controlling the symptoms caused by the excessively secreted hormones may be a therapeutic challenge. Long-acting somatostatins such as octreotide and lanreotide have become the medical treatment of choice for these symptoms. They bind to somatostatin receptors on the tumor cell and thus inhibit the uncontrolled release of hormones from the carcinoid cell.

Somatostatins are a long-term and effective treatment modality in metastatic carcinoid disease. Somatostatins control the carcinoid syndrome (flush attacks, diarrhea etc.) in the vast majority of patients. Somatostatins are also very effective drugs for the symptomatic treatment of very rare VIPomas. A major advantage of somatostatins is that they are generally well-tolerated. When used for a long period of time the occurrence of gall stones has to be looked for, since somatostatins inhibit the emptying of the gall bladder. To prevent complications caused by gall stones, carcinoid patients are advised to have their gall bladder removed when an abdominal operation is planned. Occasionally fatty stools (steatorrhoe) occur, since somatostatins can inhibit the release of pancreatic enzymes. The resulting exocrine pancreatic insufficiency can however, be easily treated by administering pancreatic enzymes.
Interferons are less well tolerated than somatostatins; therefore somatostatins are generally preferred. Interestingly, in Scandinavia interferon-alpha is used quite commonly for treating the carcinoid syndrome.

Drug therapy of carcinoid heart disease relies on the well established drugs used for cardiac insufficiency (ACE- inhibitor / AT1-receptor antagonist, diuretic, ß-blocker, aldosterone antagonist, digitalis). Surgery for carcinoid-induced valve disease is indicated by the severity of carcinoid heart disease.

Contact

Center of Neuroendocrine Tumors
Prof. Dr. med. Hans Scherübl
Vivantes Klinikum Am Urban
Academic Teaching Hospital of Charité-University Medicine, Berlin
Dieffenbachstraße 1
10967 Berlin, Germany
Tel: + 49 30 130 225201
Fax: + 49 30 130 225205
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
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