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Have melasma on forehead. Getting abdominal pain, flush on face and loose stool. Carcinoid?

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Practicing since : 1962
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thank you in advance for your care.

i'm female, 44, and i've done some homework on flushing because i'm concerned.

1. i get flushed face (mild, mostly nose and edges of cheeks toward jaws) more often lately~ sometimes emotions, sometimes after meals, and am concerned about carcinoid.

2. today was the second time ever that the pinkness of my face also included blotchiness in the v-neck area. my nose also dripped a little, while and after i was eating a warm (not spicey) meal. the first time i got the same thing with the upper chest and face together was 2 days ago, after an emotional moment. (please see picture)

2. i don't have loose or watery diarrhea (i know from research it's not always associated, only 75% vs. flushing in 90% of cases), but

3. i have had soft stools for years and

4. a year ago started getting lower left occasional abdominal dull aching in almost ovary area (ultrasound & pelvic exam show nothing)

5. new symptoms (last 3-5 months) lots of left abdominal gurgling, gas, some constipation, and lower left abdominal aches. however, last week i did have diarrhea once. i'm waiting for chromagranin-A blood test results (i requested added to the normal bloodwork my doctor is doing routinely).

i wish i could feel better about the flushing. how concerned should i be? i don't have palpitations or low blood pressure during them.

is it ever normal to flush after meals (not involving spicey foods, hot beverages, msg, the normal things)? i'm not on niacin, no food allergies, no other medical conditions.

mine aren't super bright red or intense...nor do they normally involve my neck or trunk.. it's also happened occasionally after strenous excercise. i also have melasma on my forehead and it seems a reddish patchiness in my skin tone (subtle but very visible when i blush) has spread to the cheek area (toward the jawline and ears) where i get the brightest blush as well.

thank you so very much for whatever you can offer. i'll be doing a gastro specialist visit asap anyway for the abdominal symptoms in the next week or two.

when i say soft stools over several years i mean bouts of soft stools &/or diarrhea
and then periods of normal stools

what's new in last 3-5 months is that my stools are more solid usually, normal, sometimes a little thin, sometimes soft and sometimes loose, but now also i often have moments of constipation.

i used to have more bowel movements in a day than i do now, so even when they are normal appearance in texture, they are less frequent.
Posted Tue, 12 Mar 2013 in Skin Hair and Nails
Answered by Dr. Charles S Narasi 3 hours later
Sounds like you have done your research very well.
Just looking at the rash (Flushing) and history of soft
or frequent stools, it does fit the probable diagnosis of
Carcinoid syndrome. This could be typically in the small
intestine (Close to the appendix) or could be in another
part of the bowel and even outside the bowel.
Blood and urine tests are required to confirm.
Measurement of 5-HIAA in urine and Blood Serotonin
levels will be helpful.
Enteroscopy and biopsy will confirm the diagnosis also.
Other testing includes CgA testing (ChromograninA ) which
is an antibody test through blood test.
I am sure you can discuss these with your gastroenterologist
when you see him or her.
I wish you well.
Above answer was peer-reviewed by
Follow-up: Have melasma on forehead. Getting abdominal pain, flush on face and loose stool. Carcinoid? 9 hours later
Hello & Thank you Dr. Narasi.

I understand what you have said and of course will proceed with my specialist appointment.

Please however understand that I of course would like to also hope that other diagnosis are possible, especially since my flushing is usually very mild.

Could you kindly reply with more detail about my questions regarding:

1. ESPECIALLY: other potential explanations for the kind of flushing i've described that would NOT be related to carcinoid but would occur in similar circumstances.

2. the reason that i would having fewer and more solid stools, usually regular in appearance in the last 3 months even though the abdominal discomfort has gotten more consistent

3. if IBS is a possibility (given also the location in the left (from my perspective inside my body) side of my lower abdomen near the top of my hip bone

4. what percentage of carcinoid is benign?
I thought of one other thing, excuse me..

That is,
is it possible for non-malignant carcinoids to cause carcinoid syndrome symptoms, or be "active" hormone producers?

is it possible for carcinoid syndrome symptoms to appear without mestatis to the liver?
and would the melasma on my face be related to something like a carcinoid tumor?

i do not take any hormones, nor have i been pregnant.
ultrasound of liver 1 month ago showed clear

thank you for your assistance.
Answered by Dr. Charles S Narasi 2 hours later
Carcinoid tumors typically , about 70% occur in the intestinal
tract. Occasionally they can be in the lungs and bronchial tubes.
The full syndrome is usually associated with spread to the liver.
Symptoms are caused by Serotonin excess produced by the tumor.
Skin rash can be triggered by ingestion of blue cheese,chocolate,
red wine . Avacado and certain foods that have Tyramine can
cause rash as well. Niacin deficiency has been associated and
the condition is "Pellagra" with typical skin rashes.
The only thing that I might consider is allergies to something
you may be ingesting or coming in contact with.
In such cases anti-allergy medication would help.
IBS does not cause these type of skin rashes, eventhough
Serotonin is involved, but there is no excess production.
Just the Brain-Gut reaction in individuals with IBS is different.
Once the tumor is completely removed , it is a cure.
If the tumor has spread to the liver , there are effective
treatments , like directly injectingSandostatin and sometimes
Interferon treatment.
I recommend Caring for carcinoid foundation for good information.
I wish you the very best.
Above answer was peer-reviewed by
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