Carcinoid Syndrome Associated With Pancreatic Tumors

CARCINOID tumors may originate from the stomach, duodenum, small and large intestines, and rectum, since the Kultschitzky, or argentaffin cell, from which carcinoid tumors are derived, is found in all these areas. Since these cells are also found in the gallbladder and pancreatic ducts, it is not surprising that functioning carcinoid tumors have been reported from these locations.1-3Several recent reports have described patients with a variety of pancreatic neoplasms, not of argentaffin cell origin, who nevertheless had typical carcinoid syndromes, including elevated urinary levels of the serotonin metabolite, 5-hydroxyindoleacetic acid (5-HIAA). These tumors have included adenocarcinoma of the pancreas4-7and islet cell carcinoma.8-10The latter two reports9,10described patients with hypoglycemia as well as the carcinoid syndrome. The present study describes a patient with metastatic islet cell carcinoma who had the manifestations of the carcinoid syndrome, including cutaneous telangiectasis, diarrhea, persistently increased skin pigmentation, a hyperkinetic