Carcinoid Syndrome With Gastric Hypersecretion and Histaminuria

STUDY of the systemic manifestations of malignant tumors has resulted in the delineation of a wide variety of syndromes.¹ In many instances the tumors probably manufacture substances that have endocrine-like activity. Although rather specific syndromes were described initially, further case reports indicate more complex interrelationships among syndromes. The metastatic carcinoid tumor illustrates the diverse biochemical potential of the malignant cell. Biörck and associates² in 1952 first described the clinical picture; Thorson³ in 1958, summarizing the literature to that time, described a rather characteristic syndrome of diarrhea and flushing that was sometimes associated with cardiac lesions and bronchial constriction. Central to this syndrome are hepatic metastases from carcinoid tumors producing high levels of various indoles in the serum and urine.^4,5 Since 1958, many cases have been described that are atypical in respect to clinical symptoms, biochemical findings, and tissue of origin. These tumors are often associated with other "endocrine" tumors.^8,7 The