Pressor Amines and the Carcinoid Flush

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Abstract
The effects of intravenous infusion of various pressor amines in 13 patients with the malignant carcinoid syndrome were studied. Typical carcinoid flush reactions were provoked with injections of small amounts of epinephrine, norepinephrine, and iso-proterenol. Larger doses of tyramine, metaraminol and mephenter-mine were required to produce flush responses. Methoxamine infusions were followed only occasionally by minor flush reactions. Large doses of serotonin were required to produce flushes which bore little resemblance to spontaneous carcinoid flushes. The urinary excretion of the catecholamines and their metabolites was within the normal range in all but 1 patient (in whom slightly elevated levels were found). Plamsa tyrosine and urinary tyramine concentrations were normal or slightly diminished. Very low concentrations of plasma tryptophan and urinary tryptamine in some patients were attributed to the large amounts of tryptophan used in the synthesis of 5 hydroxy-indoles in patients with carcinoid tumors. The effect of oral administrations of 2 adrenolytic drugs, phentolamine and dibenzyline, were studied in several patients. In those patients in whom the use of these drugs was not limited by intolerable side effects, satisfactory relief from flushing was obtained. Of the two, dibenzyline appeared to be the better drug for this purpose. The use of intravenous injections of small doses of epinephrine to provoke flushes was proposed as a simple bedside aid to diagnosis of the malignant carcinoid syndrome.

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