{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T16:29:13Z","timestamp":1793896153056,"version":"4.8.0"},"reference-count":50,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2022,1,28]],"date-time":"2022-01-28T00:00:00Z","timestamp":1643328000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Carcinoid Crisis represents a rare and extremely dangerous manifestation that can occur in patients with Neuroendocrine Tumors (NETs). It is characterized by a sudden onset of hemodynamic instability, sometimes associated with the classical symptoms of carcinoid syndrome, such as bronchospasm and flushing. Carcinoid Crisis seems to be caused by a massive release of vasoactive substances, typically produced by neuroendocrine cells, and can emerge after abdominal procedures, but also spontaneously in rare instances. To date, there are no empirically derived guidelines for the management of this cancer-related medical emergency, and the available evidence essentially comes from single-case reports or dated small retrospective series. A transfer to the Intensive Care Unit may be necessary during the acute setting, when the severe hypotension becomes unresponsive to standard practices, such as volemic filling and the infusion of vasopressor therapy. The only effective strategy is represented by prevention. The administration of octreotide, anxiolytic and antihistaminic agents represents the current treatment approach to avoid hormone release and prevent major complications. However, no standard protocols are available, resulting in great variability in terms of schedules, doses, ways of administration and timing of prophylactic treatments.<\/jats:p>","DOI":"10.3390\/cancers14030662","type":"journal-article","created":{"date-parts":[[2022,1,29]],"date-time":"2022-01-29T01:41:59Z","timestamp":1643420519000},"page":"662","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Carcinoid Crisis: A Misunderstood and Unrecognized Oncological Emergency"],"prefix":"10.3390","volume":"14","author":[{"given":"Camilla","family":"Bardasi","sequence":"first","affiliation":[{"name":"Department of Oncology and Hematology, Division of Oncology, University Hospital of Modena, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"Benatti","sequence":"additional","affiliation":[{"name":"Department of Oncology and Hematology, Division of Oncology, University Hospital of Modena, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Luppi","sequence":"additional","affiliation":[{"name":"Department of Oncology and Hematology, Division of Oncology, University Hospital of Modena, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid","family":"Garajov\u00e0","sequence":"additional","affiliation":[{"name":"Medical Oncology Unit, University Hospital of Parma, 43100 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8969-638X","authenticated-orcid":false,"given":"Federico","family":"Piacentini","sequence":"additional","affiliation":[{"name":"Department of Oncology and Hematology, Division of Oncology, University Hospital of Modena, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Dominici","sequence":"additional","affiliation":[{"name":"Department of Oncology and Hematology, Division of Oncology, University Hospital of Modena, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7979-4795","authenticated-orcid":false,"given":"Fabio","family":"Gelsomino","sequence":"additional","affiliation":[{"name":"Department of Oncology and Hematology, Division of Oncology, University Hospital of Modena, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1016\/0002-9343(56)90136-X","article-title":"A clinical, physiologic and biochemical study of patients with malignant car-cinoid (argentaffinoma)","volume":"20","author":"Sjoerdsma","year":"1956","journal-title":"Am. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1001\/archinte.1964.03860070072004","article-title":"The carcinoid crisis","volume":"114","author":"Kahil","year":"1964","journal-title":"Arch. Intern. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S95","DOI":"10.1093\/annonc\/12.suppl_2.S95","article-title":"Epidemiology, clinical features and diagno-sis of gastroenteropancreatic endocrine tumours","volume":"12","author":"Tomassetti","year":"2001","journal-title":"Ann. Oncol."},{"key":"ref_4","first-page":"143","article-title":"Carcinoid crisis 24 h after bland embolization: A case report","volume":"4","author":"Fujie","year":"2010","journal-title":"Biosci. Trends"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1053\/crad.1999.0167","article-title":"Carcinoid crisis provoked by mammographic compression of metastatic carcinoid tu-mour of the breast","volume":"56","author":"Ozgen","year":"2001","journal-title":"Clin. Radiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1007\/s001340050060","article-title":"Carcinoid crisis during transesophageal echocardiography","volume":"26","author":"Salm","year":"2000","journal-title":"Intensiv. Care Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1111\/j.1445-5994.2012.02719.x","article-title":"Carcinoid crisis induced by repeated abdominal examination","volume":"42","author":"Morrisroe","year":"2012","journal-title":"Intern. Med. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1016\/j.jvir.2013.10.054","article-title":"Sudden death from carcinoid crisis during image-guided biopsy of a lung mass","volume":"25","author":"Magabe","year":"2014","journal-title":"J. Vasc. Interv. Ra-diol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1093\/bja\/87.3.447","article-title":"Perianaesthetic risks and outcomes of abdominal surgery for metastatic carcinoid tumours \u2020","volume":"87","author":"Kinney","year":"2001","journal-title":"Br. J. Anaesth."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1002\/jso.23323","article-title":"Octreotide LAR and bolus octreotide are insufficient for preventing intraoperative complications in carcinoid patients","volume":"107","author":"Massimino","year":"2013","journal-title":"J. Surg. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/j.surg.2015.05.036","article-title":"Continuous infusion of octreotide combined with perioperative octreotide bolus does not prevent intraoperative carcinoid crisis","volume":"159","author":"Condron","year":"2016","journal-title":"Surgery"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1097\/MPA.0000000000001271","article-title":"Periprocedural management of patients undergoing liver resection or embolotherapy for neuroendocrine tumor me-tastases","volume":"48","author":"Kwon","year":"2019","journal-title":"Pancreas"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1007\/BF00446228","article-title":"Tryptophan in the treatment of carcinoid crisis","volume":"10","author":"Harris","year":"1983","journal-title":"Cancer Chemother. Pharmacol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1177\/0310057X8901700324","article-title":"Carcinoid syndrome: The combined use of ketanserin and octreotide in the management of an acute crisis during anaesthesia","volume":"17","author":"Hughes","year":"1989","journal-title":"Anaesth. Intensiv. Care"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1093\/bja\/69.3.325","article-title":"Anaphylactoid or carcinoid?","volume":"69","author":"Batchelor","year":"1992","journal-title":"Br. J. Anaesth."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2489","DOI":"10.1093\/oxfordjournals.ndt.a027221","article-title":"Acute renal failure associated with carcinoid crisis","volume":"11","author":"Parry","year":"1996","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_17","first-page":"1240","article-title":"Carcinoid crisis after injection of 6-18F-fluorodihydroxyphenylalanine in a patient with metastatic carcinoid","volume":"46","author":"Koopmans","year":"2005","journal-title":"J. Nucl. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1097\/MEG.0b013e3282294d88","article-title":"Carcinoid syndrome and carcinoid crisis secondary to a metastatic carcinoid tumour of the lung: A therapeutic challenge","volume":"19","author":"Papadogias","year":"2007","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1007\/s12630-013-0026-4","article-title":"A case of acute respiratory distress syndrome responsive to methylene blue during a carcinoid crisis","volume":"60","author":"Sobey","year":"2013","journal-title":"Can. J. Anaesth."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"443","DOI":"10.4103\/ija.IJA_161_17","article-title":"Intra-operative carcinoid crisis: Revised anaesthesia management","volume":"61","author":"Kromas","year":"2017","journal-title":"Indian J. Anaesth."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2068","DOI":"10.1016\/j.jaccas.2020.08.026","article-title":"Carcinoid crisis\u2013induced acute systolic heart failure","volume":"2","author":"Maddali","year":"2020","journal-title":"JACC Case Rep."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/j.jcrc.2020.08.011","article-title":"Octreotide for resuscitation of cardiac arrest due to carcinoid crisis precipitated by novel peptide receptor radionuclide therapy (PRRT): A case report","volume":"60","author":"Dhanani","year":"2020","journal-title":"J. Crit. Care"},{"key":"ref_23","first-page":"e15626","article-title":"A Challenging case of carcinoid crisis in a patient with neuroendocrine tumor","volume":"13","author":"Mahdi","year":"2021","journal-title":"Cureus"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Del Olmo-Garc\u00eda, M.I., Muros, M.A., L\u00f3pez-De-La-Torre, M., Agudelo, M., Bello, P., Soriano, J.M., and Merino-Torres, J.-F. (2020). Pre-vention and management of hormonal crisis during theragnosis with LU-DOTA-TATE in neuroendocrine tumors. A system-atic review and approach proposal. J. Clin. Med., 9.","DOI":"10.3390\/jcm9072203"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1007\/s12630-012-9879-1","article-title":"Mega-dose intravenous octreotide for the treatment of carcinoid crisis: A systematic review","volume":"60","author":"Seymour","year":"2013","journal-title":"Can. J. Anaesth."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/j.surg.2018.04.093","article-title":"A prospective study of the pathophysiology of carcinoid crisis","volume":"165","author":"Condron","year":"2018","journal-title":"Surgery"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1111\/j.1365-2982.2009.01370.x","article-title":"Understanding the role of tryptophan and serotonin metabolism in gastrointes-tinal function","volume":"21","author":"Keszthelyi","year":"2009","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_28","first-page":"846","article-title":"Serotonin: A review","volume":"102","author":"Sirek","year":"1970","journal-title":"Can. Med. Assoc. J."},{"key":"ref_29","first-page":"103","article-title":"The mechanism of facial flushes in the carcinoid syndrome","volume":"31","author":"Robertson","year":"1962","journal-title":"Quart. J. Med."},{"key":"ref_30","first-page":"104","article-title":"THE carcinoid spectrum","volume":"47","author":"Sjoerdsma","year":"1964","journal-title":"Gastroenterology"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1097\/01.sla.0000167862.52309.7d","article-title":"Gastric carcinoids: Biologic behavior and prognosis after differentiated treatment in relation to type","volume":"242","author":"Borch","year":"2005","journal-title":"Ann. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1016\/0002-9343(65)90080-X","article-title":"Distinctive clinical and therapeutic aspects of the syndrome associated with bronchial carcinoid tumors","volume":"39","author":"Melmon","year":"1965","journal-title":"Am. J. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1016\/S0140-6736(64)92907-1","article-title":"Release of a kinin peptide in the carcinoid syndrome","volume":"1","author":"Oates","year":"1964","journal-title":"Lancet"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/j.anclin.2017.01.021","article-title":"Pharmacology of octreotide: Clinical implications for anesthe-siologists and associated risks","volume":"35","author":"Borna","year":"2017","journal-title":"Anesthesiol. Clin."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1056\/NEJM199601253340408","article-title":"Octreotide","volume":"334","author":"Lamberts","year":"1996","journal-title":"N. Engl. J. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1056\/NEJM198511073131916","article-title":"Rapid reversal of carcinoid crisis with somatostatin analogue","volume":"313","author":"Kvols","year":"1985","journal-title":"N. Engl. J. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1056\/NEJM198609113151102","article-title":"Treatment of the malignant carcinoid syndrome evaluation of a long-acting somatostatin analogue","volume":"315","author":"Kvols","year":"1986","journal-title":"N. Engl. J. Med."},{"key":"ref_38","first-page":"349","article-title":"Octreotide treatment of carcinoid hypertensive crisis","volume":"61","author":"Warner","year":"1994","journal-title":"Mt. Sinai J. Med. A J. Transl. Pers. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1093\/bja\/72.3.335","article-title":"Review of the anaesthetic management of 21 patients under-going laparotomy for carcinoid syndrome","volume":"72","author":"Veall","year":"1994","journal-title":"Br. J. Anaesth."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Wonn, S.M., and Pommier, R.F. (2021). Carcinoid crisis: History, dogmas, and data. Neuroendocrine Tumors, Springer.","DOI":"10.1007\/978-3-030-62241-1_6"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.jclinane.2016.03.008","article-title":"Development of effective prophylaxis against intraoperative carcinoid crisis","volume":"32","author":"Woltering","year":"2016","journal-title":"J. Clin. Anesth."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.jclinane.2018.08.005","article-title":"Partial hepatic resections for metastatic neuroendocrine tumors: Perioperative outcomes","volume":"51","author":"Kinney","year":"2018","journal-title":"J. Clin. Anesth."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1159\/000461583","article-title":"ENETS consensus guidelines for the standards of care in neuroendocrine tumors: Pre- and perioperative therapy in patients with neuroendocrine tumors","volume":"105","author":"Kaltsas","year":"2017","journal-title":"Neuroendocrinology"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1007\/s00259-007-0691-z","article-title":"Hormonal crises following receptor radionuclide therapy with the radiolabeled somatostatin analogue [177Lu-DOTA0,Tyr3]octreotate","volume":"35","author":"Feelders","year":"2008","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_45","first-page":"9810194","article-title":"Fatal systemic vasoconstriction in a case of metastatic small-intestinal NET","volume":"2017","author":"Stenzel","year":"2017","journal-title":"Rep. Gastrointest. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ctrv.2018.03.002","article-title":"Prevention and management of carcinoid crises in patients with high-risk neuroendocrine tumours undergoing peptide receptor radionuclide therapy (PRRT): Literature review and case series from two Australian tertiary medical institutions","volume":"66","author":"Rico","year":"2018","journal-title":"Cancer Treat. Rev."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.7326\/0003-4819-65-6-1334","article-title":"New understanding of the mechanism of the carcinoid flush","volume":"65","author":"Mason","year":"1966","journal-title":"Ann. Intern. Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1016\/j.amjsurg.2018.12.070","article-title":"\u0392-Adrenergic agonist administration is not asso-ciated with secondary carcinoid crisis in patients with carcinoid tumor","volume":"217","author":"Limbach","year":"2019","journal-title":"Am. J. Surg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1097\/MPA.0000000000000846","article-title":"The surgical management of small bowel neuroendocrine tumors: Consensus guidelines of the north american neuroendo-crine tumor society","volume":"46","author":"Howe","year":"2017","journal-title":"Pancreas"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.surg.2021.03.063","article-title":"A prospective study of carcinoid crisis with no perioperative octreotide","volume":"171","author":"Wonn","year":"2021","journal-title":"Surgery"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/14\/3\/662\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:09:57Z","timestamp":1760134197000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/14\/3\/662"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,28]]},"references-count":50,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,2]]}},"alternative-id":["cancers14030662"],"URL":"https:\/\/doi.org\/10.3390\/cancers14030662","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,28]]}}}