Oncology · Carcinoid Crisis

What is a Carcinoid Crisis During Surgery?

At a Glance

A carcinoid crisis is a rare, severe hormone surge triggered by neuroendocrine tumor surgery or anesthesia. Medical teams prevent and manage this by administering intravenous octreotide before and during the operation to block hormone release and safely stabilize blood pressure.

A carcinoid crisis is a rare but severe, life-threatening event where a serotonin-producing neuroendocrine tumor (often called a carcinoid tumor) suddenly releases a massive amount of hormones (vasoactive substances) into the bloodstream ^[1]^[2]. This dangerous hormone surge is most often triggered by the physical stress of surgery, the administration of anesthesia, or the surgeon directly handling the tumor during an operation ^[3].

When these hormones flood the system, they can cause dangerous fluctuations in blood pressure, heart rate, and breathing—such as sudden airway spasms known as bronchospasms ^[4]. Because this is a known risk for patients with these specific types of tumors, medical teams use highly specialized care plans (perioperative management) to stabilize the tumor and protect the patient before, during, and after surgery ^[5]^[6].

How Doctors Prevent Carcinoid Crisis

To prevent a crisis, your surgical and anesthesia teams will typically use a standardized protocol centered around a medication called octreotide ^[7]. Octreotide is a synthetic hormone (somatostatin analog) that blocks the tumor from releasing its stored hormones ^[3].

Intravenous (IV) Octreotide: This medication is often administered intravenously starting in the pre-op area before surgery begins and continued as a steady drip throughout the operation and into the recovery room to keep the tumor stabilized ^[3]^[8].
Other Protective Medications: In addition to octreotide, your anesthesiologist may give you antihistamines and anti-anxiety medications (anxiolytics) to further calm your body and prevent hormone release ^[3].
Vigilant Monitoring: During the surgery, the anesthesia team will meticulously monitor your blood pressure and heart function ^[9]. They tailor the anesthesia specifically for your condition to avoid triggering the tumor ^[10].

While IV octreotide is the standard of care for preventing a crisis, some recent medical literature suggests that in certain cases, it may not completely eliminate the risk on its own ^[11]^[12]. Therefore, your team will be prepared with backup plans.

What Happens if a Crisis Occurs?

If a carcinoid crisis begins despite preventive measures, please know that you will be under general anesthesia, completely asleep, and unaware while your team manages the event. The anesthesia team acts immediately. They will typically administer additional high doses of octreotide ^[13]. If the blood pressure drops severely and does not respond to octreotide (a condition known as refractory crisis), they will use powerful medications called vasopressors to safely elevate your blood pressure and stabilize your heart ^[2]^[14].

Who is at the Highest Risk?

You may be at a higher risk of experiencing a carcinoid crisis during surgery if you already suffer from carcinoid syndrome (frequent flushing, diarrhea) or if the hormones have affected your heart valves (a condition called carcinoid heart disease) ^[7]^[15]. It is crucial that your surgical team is experienced in treating neuroendocrine tumors so they can accurately assess your risk and prepare accordingly ^[16]. Be sure to discuss whether you need to adjust your at-home medications or take extra oral octreotide in the days leading up to your operation.

Common questions in this guide

What triggers a carcinoid crisis during surgery?

A carcinoid crisis is typically triggered by extreme physical stress to the body. During an operation, this hormone surge can be caused by the administration of anesthesia or when the surgeon directly handles the neuroendocrine tumor.

How do doctors prevent a carcinoid crisis?

Medical teams follow a specialized protocol centered around a medication called octreotide. This drug is given intravenously starting before surgery and continued throughout the operation to block the tumor from releasing its stored hormones.

What happens if a carcinoid crisis occurs while I am in surgery?

If a crisis happens, you will be asleep under general anesthesia and completely unaware. Your anesthesia team will act immediately by administering higher doses of octreotide and using powerful medications called vasopressors to stabilize your blood pressure and heart rate.

Who is most at risk for a carcinoid crisis?

Patients who already experience symptoms of carcinoid syndrome, such as frequent flushing or diarrhea, are at a higher risk. Additionally, those who have developed carcinoid heart disease face an increased risk during surgical procedures.

Curated prompts to bring to your next appointment.

1.How many neuroendocrine tumor surgeries do you perform each year?
2.What is your specific protocol for preventing a carcinoid crisis during my operation?
3.Will I receive an IV octreotide drip, and when will it start on the day of surgery?
4.Who will be monitoring my heart and blood pressure during the surgery, and are they experienced with carcinoid crisis?
5.Should I adjust my oral somatostatin analogs or take any extra doses in the days before my surgery?

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

Related questions

Are Endocrine Tumors Benign or Malignant?Are Endocrine Tumors Hereditary? Testing Guide What Are the Symptoms of Carcinoid Syndrome?Endocrine Tumors: Why Do They Cause Weight Gain & High BP?What Foods to Avoid Before an Endocrine Tumor Test?What Is a Functional vs Non-Functional Endocrine Tumor?Why Do I Need a DOTATATE PET Scan for NETs?Will I Need Hormone Therapy After Gland Removal?Who Treats Endocrine Tumors? Your Care Team Explained NET vs. NEC Neuroendocrine Tumors: What's the Difference?How Does PRRT (Lutathera) Work for Neuroendocrine Tumors?Why Is Biopsy Dangerous for Suspected Pheochromocytoma?Why Does MEN2 Require Preventative Thyroid Surgery?Somatostatin Analogs (SSAs) for NETs: What to Expect What is the Ki-67 Index in Neuroendocrine Tumors (NETs)?

References (16)

1
Partial hepatic resections for metastatic neuroendocrine tumors: perioperative outcomes.
Kinney MAO, Nagorney DM, Clark DF, et al.
Journal of clinical anesthesia 2018; (51()):93-96 doi:10.1016/j.jclinane.2018.08.005.
PMID: 30098573
2
A Challenging Case of Carcinoid Crisis in a Patient With Neuroendocrine Tumor.
Mahdi M, Ozer M, Tahseen M
Cureus 2021; (13(6)):e15626 doi:10.7759/cureus.15626.
PMID: 34277243
3
Carcinoid Crisis: A Misunderstood and Unrecognized Oncological Emergency.
Bardasi C, Benatti S, Luppi G, et al.
Cancers 2022; (14(3)) doi:10.3390/cancers14030662.
PMID: 35158931
4
Carcinoid heart disease in patients with midgut neuroendocrine tumours.
Delhomme C, Walter T, Arangalage D, et al.
Journal of neuroendocrinology 2023; (35(4)):e13262 doi:10.1111/jne.13262.
PMID: 37005217
5
The impact of failure to achieve symptom control after resection of functional neuroendocrine tumors: An 8-institution study from the US Neuroendocrine Tumor Study Group.
Zaidi MY, Lopez-Aguiar AG, Poultsides GA, et al.
Journal of surgical oncology 2019; (119(1)):5-11 doi:10.1002/jso.25306.
PMID: 30481383
6
Catheter Ablation in Patients With Neuroendocrine (Carcinoid) Tumors and Carcinoid Heart Disease: Outcomes, Peri-Procedural Complications, and Management Strategies.
Shabtaie SA, Luis SA, Ward RC, et al.
JACC. Clinical electrophysiology 2021; (7(2)):151-160 doi:10.1016/j.jacep.2020.08.009.
PMID: 33602395
7
Intraoperative carcinoid syndrome during small-bowel neuroendocrine tumour surgery.
Fouché M, Bouffard Y, Le Goff MC, et al.
Endocrine connections 2018; (7(12)):1245-1250.
PMID: 30352418
8
ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: Pre- and Perioperative Therapy in Patients with Neuroendocrine Tumors.
Kaltsas G, Caplin M, Davies P, et al.
Neuroendocrinology 2017; (105(3)):245-254 doi:10.1159/000461583.
PMID: 28253514
9
Perioperative management of a double valve replacement and coronary artery bypass graft in a patient with carcinoid syndrome; a case report and literature review.
Sarridou DG, Gkiouliava A, Argiriadou H, et al.
Perfusion 2025; (40(3)):766-769 doi:10.1177/02676591241247977.
PMID: 38626318
10
Lutetium therapy-induced carcinoid crisis: A case report and review of literature.
Yadav SK, Jha CK, Patil S, et al.
Journal of cancer research and therapeutics 2020; (16(Supplement)):S206-S208 doi:10.4103/jcrt.JCRT_22_18.
PMID: 33380679
11
Letter to the Editor Concerning "Comparison of Octreotide and Vasopressors as First-Line Treatment for Intraoperative Carcinoid Crisis" by Ammann, Markus et al.
Pommier R
Annals of surgical oncology 2024; (31(8)):5130-5131 doi:10.1245/s10434-024-15455-x.
PMID: 38844630
12
Carcinoid crisis: The challenge is still there.
Guerrero-Pérez F, Peiró I, Vercher-Conejero JL, et al.
Endocrinologia, diabetes y nutricion 2024; (71(6)):263-270 doi:10.1016/j.endien.2024.03.020.
PMID: 38986629
13
Comparison of Octreotide and Vasopressors as First-Line Treatment for Intraoperative Carcinoid Crisis.
McCully BH, Kozuma K, Pommier S, Pommier RF
Annals of surgical oncology 2024; (31(5)):2996-3002 doi:10.1245/s10434-023-14876-4.
PMID: 38227166
14
Carcinoid Crisis-Induced Acute Systolic Heart Failure.
Maddali MV, Chiu C, Cedarbaum ER, et al.
JACC. Case reports 2020; (2(13)):2068-2071 doi:10.1016/j.jaccas.2020.08.026.
PMID: 34317110
15
Balancing carcinoid crisis and right ventricular dysfunction during tricuspid and pulmonic valve replacement for carcinoid heart disease: A case report.
Pagryzinski AR, Schena S, Novalija J, et al.
International journal of surgery case reports 2023; (102()):107855 doi:10.1016/j.ijscr.2022.107855.
PMID: 36610355
16
[Neuroendocrine well-differentiated pancreatic tumors].
Niccoli P
La Revue du praticien 2015; (65(4)):461-5.
PMID: 26058180

This page is for informational purposes only and does not replace professional medical advice. Always consult your surgeon and anesthesiologist about your specific risks and preparation for neuroendocrine tumor surgery.

Get notified when new evidence is published on Tumor of endocrine glands.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.