CASE 6

White Male With Red Face

• A 43 year old white male comes to you with the chief complaint of flushing of the face, watery diarrhea .

• The physical exam reveals a medium built white male with redness of the face, increased intestinal sounds, and malar telangiectasias.

• Thoracic exam reveals wheezing and the cardiac exam reveals tricuspid regurgitation.

• His laboratory tests only reveal increased glucose in serum and glucose intolerance.

• Stool reveals 5+ guaic. (Fecal Occult Blood)

Which Test?

• ACTH • Gastrin • Urinary 5-

hydroxyindoleactic acid

• urinary 5-hydroxyindoleactic acid. The most informative test in this case would be 5-HIAA.

Before Urine Test

• the patient must not eat which of the following?

• Meat • Broccoli • Bananas

• Bananas. Also, pineapple, kiwi, eggplant, plums, tomatoes avocados walnuts and other nuts can increase HIAA levels and must therefore not be ingested before measuring

• Our patient had 45mg of 5-HIAA in 24 hour urine as well increased serum serotonin after a diet free of the items mentioned in this page. Now, what is your recommendation:

• Bronchoscopy

• GI series and endoscopy

• Cystoscopy

GI series and endoscopy

• The patient had an ulcerated submucosal mass in the duodenum measuring about 3cm.