A 63-year-old woman presents with a 6-month history of recurrent epigastric pain and nausea. Abdominal ultrasound reveals a 13-mm hypoechoic lesion in the tail of the pancreas. Physical examination shows flushing of the face, periorbital edema, and hypotension (blood pressure =90/50 mm Hg). Laboratory studies disclose normal serum levels of gastrin, amylase, insulin, and vasoactive intestinal polypeptide. Urinalysis demonstrates elevated levels of metanephrines (10 mg per 24 hours). Which of the following is the most likely diagnosis?
High-Yield Explanation
Carcinoid tumors of the pancreas are rare malignant neoplasms that closely resemble intestinal carcinoids. When confined to the pancreas, they may induce the so-called atypical carcinoid syndrome, which is associated with severe facial flushing, hypotension, periorbital edema, and tearing. Hepatic metastases cause the full-blown carcinoid syndrome. Adenocarcinoma of the pancreas (choice A) does not produce hormones. The other choices lead to other endocrine syndromes.Diagnosis: Carcinoid tumor