Acute renal failure in carcinoid syndrome crisis

The release of vasoactive substances into the circulation is the major contributing factor for symptoms in the carcinoid syndrome. Acute renal failure has been described in some patients with carcinoid tumors undergoing chemoembolisation of liver metastases and treatment with interferon-α. We describe a patient without such treatment and acute renal failure during carcinoid syndrome crisis. A 55 year old man with a known metastatic carcinoid tumor was admitted with persisting facial flushing over many hours. He has been operated on a primary non-functioning neuroendocrine tumor of the left lung in 1988. During the last months facial flushing appeared periodically lasting for up to two hours with spontaneous remission. At hospital admission flushing was accompanied by tachycardia of 120–140 beats per minute, fever up to 38.2 degrees Celsius and severe weakness. Blood-pressure was in the low-normal range. Serum creatinine increased from 1.0mg/dl up to 5.9mg/dl within 24 hours. N-acetyl-cystein-(NAC)-activated creatinkinase (CK) and the isoenzyme CK-MB were markedly elevated (2342 U/L and 4630 U/L, respectively). Despite intravenous fluid therapy the patient developed anuria. Hemodialysis was performed one time. Octreotide was given intravenously in a dosis of 100µg/hour intravenously. This high-dose treatment with octreotide could interrupt the carcinoid syndrome crisis after 18 hours. A phase of polyuria was followed by complete normalisation of renal function. After switching to subcutaneous delivery of octreotide (3×100µg/day) symptoms of the carcinoid syndrome did not reoccur. Serotonine values in serum and diurnal urinary excretion of 5-hydroxyindoleacetic acid were extremely elevated. Magnetic resonance imaging demonstrated extensive liver metastases while octreotide scan confirmed metastatic bone disease. Echocardiography could show only subtle changes of carcinoid heart diseae.

Conclusion: Metastasised carcinoid tumours may induce acute renal failure while early high dose octreotide may prevent permanent renal damage.