EVAR and ? carcinoid

Gabrielle Morris

84yo male with 5cm AAA for EVAR

Background

  • Nil CVS/RS dx
  • Essential tremor
  • MOCA 24/30
  • Fungal sinusitis

Issues

? Carcinoid

  • 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.

Plan

  • Proceed with the EVAR