Functioning metastatic bronchial carcinoid with elevated levels of serum and cerebrospinal fluid serotonin and pituitary adenoma.

Abstract

A patient is described who had metastasizing bronchial carcinoid, hyperserotonemia, and an elevated urinary excretion of 5-hydroxy-3-indole acetic acid in the absence of the clinical characteristics of the carcinoid syndrome. During administration of reserpine there was an initial 5-hydroxy-3-indoluria, and excretion remained at levels above normal. A carcinoid metastasis to the choroid of the eye was found at operation, and there was possible metastatic involvement of the brain, based on an elevated level of serotonin in the cerebrospinal fluid. Associated was a pituitary adenoma with clinical evidence of acromegaly. It is suggested that patients with bronchial carcinoid undergo serotonin studies whether the carcinoid syndrome be present or not, and that these cases be scrutinized for additional endocrine adenomas. THE carcinoid syndrome associated with metastasizing bronchial adenoma was recently described by Warner and Southren (1). The present report deals with an additional patient, in whom hyperserotonemia and an increase in the urinary excretion of 5-hydroxy-3-indole acetic acid was found in the absence of the clinical characteristics of the carcinoid syndrome. There was also an elevation of the serotonin content of the cerebrospinal fluid, a finding which suggested metastatic involvement of the brain. A pituitary adenoma with clinical evidence of acromegaly added to the unusual features of this case.