84yo male with 5cm AAA for EVAR
- Nil CVS/RS dx
- Essential tremor
- MOCA 24/30
- Fungal sinusitis
- Recent hospitalization with severe pruritic rash, postural dizziness, flushing. Suggestion of carcinoid syndrome but no testing undertaken.
- Vascular surgeons happy to defer surgery given AAA 5cm, nil overly concerning imaging findings and asymptomatic
- Panel of biomarkers arranged
- Serotonin, glucagon, VIP, urinary 5HIA, chromogranin A
- Chromogranin A elevated (320) however PPIs and H2 antagonists can lead to elevations
- Endocrinologists queried mastocytosis, however tryptase level was normal
- Endocrinologists said that the flush did not sound like a carcinoid flush and were confident that this did NOT represent carcinoid syndrome
- Rash biopsied (non-specific), commenced on an IL inhibitor for the rash. This medication (like many new monoclonal therapies) does not have an associated infection risk and does not need to be withheld perioperatively.
- Proceed with the EVAR