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History of carcinoid syndrome. Done CT scan. What does report mean?

HISTORY: 53-year-old male. Carcinoid syndrome . Flushing and diarrhea. Elevated serum chromogranin A level. Reportedly normal 24 hour HIAAA. Technique: 6.21 millicuries of indium 111 pentetreotide (OctreoScan) was injected intravenously on 03/20/2013. Twenty-four hour planar whole body images were obtained on 03/21/13. Twenty-four hour SPECT CT images of the abdomen were also obtained. Additional 48 hour delayed SPECT CT images of the chest abdomen and pelvis were obtained on 03/22/13. The low-dose noncontrast CT images were obtained for attenuation correction and anatomic correlation only. The SPECT CT images were reviewed on the Siemens Leonardo SPECT CT workstation. Findings: There is physiologic uptake of activity by the thyroid gland, liver, gallbladder , spleen , GI and GU tracts. The head, neck and thorax appear unremarkable. Within the abdomen, the liver has a mildly inhomogeneous appearance. This degree of inhomogeneity is probably within normal limits. The spleen, pancreas and adrenal glands appear normal. The appendiceal region appears unremarkable. There is no convincing evidence for a carcinoid tumor primary lesion. The inguinal regions appear unremarkable. The upper and lower extremities appear unremarkable. Impression: 1. The liver has a mildly inhomogeneous appearance. This is probably within normal limits but is nonspecific. Consider further evaluation of the liver with an alternative modality such as hepatic ultrasound, a diagnostic CT scan of the liver or an hepatic MRI scan. 2. Otherwise normal indium 111 OctreoScan study. Dictated by Geoffrey Bodeau @ Mar 22 2013 3:26PM (Electronically Signed) Does this mean that I don t have carcinoid syndrome?
Asked On : Tue, 26 Mar 2013
Answers:  2 Views:  69
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General & Family Physician 's  Response

The answer to your question "I , DON'T HAVE CARCINOID SYNDROME?" is - You do have the CARCINOID SYNDROME,

Lets go through each test and its result and what does it mean,

1) HIAAA - 24 hrs- Normal (which is major indicator on carcinoid syndrome in most cases)
2) INDIUM 111 pentetreotide (OctreoScan) which is normal (saying that 80% less chances of having issues with pituitary gland, thyroid gland, liver, spleen and urinary bladder )
3) SPECT CT images normal ( means 80% less chances having tumors in spleen, pancreas and adrenal) 4) Hepatic ultrasound Normal ( No issues the liver in ultrasound found of any kind visible yet)

5) CHROMOGRANIN A- ELEVATED - Is produced by chromaffin cells of the adrenal medulla, paraganglia, enterochromaffin-like cells and beta cells of the pancreas

And the increased "CHROMOGRANIN- A" is the culprit for the" CARCINOID SYNDROME SYMPTOMS"

[{ CT SPECT , INDIUM 111 pentetreotide are only 80% time correct so normal scan will give 80% confirmation for disease freeness }]
Answered: Wed, 27 Mar 2013
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General & Family Physician Dr. Sunil 's  Response
Thanks for your query.
I have read your CT scan report, it shows no convincing evidence for carcinoid syndrome. However, they have little doubt about liver if something is hidden there.
Chromogranin A is a marker which helps in diagnosing certain diseases like pheocromocytoma, carcinoid syndrome, prostratic and pancreatic tumors.
You CT scan dose not give convincing clue about above mentioned diseases. You are advised to visit concerned doctor and evaluate Diabetes ( it may elevate chromogranin A) and LFTs for liver.

Hope it helps.
Take Care!
Answered: Wed, 27 Mar 2013
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