Flush... Indication of Carcinoid?
May 29, 2020 | 20,00 EUR | answered by Dr. med. Ralf Berg
Hello,
I have a question for an experienced doctor who has experience in treating carcinoid syndrome.
For about 5 years, after drinking alcohol, I have had a red face (flush). It usually takes about 5 minutes after drinking alcohol. Then my face starts to turn red and I feel warm in my face.
The flush only spreads in my face... on my forehead, cheeks, and ears.
I have noticed that it used to only happen with wine, champagne. Eventually, it also happened with beer, even with shandy.
Now I have read a lot online and gotten scared, as I read that it could be a carcinoid...
My question:
Is it actually possible? Are there any other indications, symptoms that occur with a carcinoid of the stomach or elsewhere?
About me: I am 29 years old, have had type 2 diabetes for 2 years which is well controlled with Metformin tablets (HbA1c 5.9)... Due to slight overweight, the doctor noticed that I have a slight fatty liver. I also have had a bee sting and wasp sting allergy for 15 years.
I am very worried now...
Could the flush be related to something else? What could it be? I also wonder why the redness of my face is sometimes stronger and sometimes weaker. With beer, sometimes I can drink 2-3 bottles without anything happening... or just feeling slightly warm.
I would be very grateful for a response... Which doctor should I consult in this case?
Dear questioner,
I understand your fear, but I can also reassure you and hopefully give you some good advice.
A flush not only occurs in carcinoid syndrome but also in many other diseases related to allergies. Everything you have described can be attributed to a reaction to alcohol. Alcohol causes dilation of the blood vessels in the skin in every person, depending on the dose. In some people, like yourself, this reaction can be excessive and lead to the symptoms you described. A certain allergic predisposition plays a role in intensifying this effect. Alcohol is just the trigger. It is not surprising that the amount consumed is very small. Like any allergic reaction, this can worsen over time. There are also phases where this reaction is very mild or does not occur at all.
Of course, flushing is also known in carcinoids, but the average age of onset is 59 years. The most common form, gastrointestinal carcinoid, is often accompanied by abdominal and stomach complaints, cramps, and possibly shortness of breath. Lung carcinoids are even rarer and can also cause shortness of breath and difficulty breathing. In Germany, it is estimated that only about 1500-3000 people are diagnosed with carcinoid in a year (all forms).
If you want to see a doctor, an endocrinologist is the specialist to consult. The initial examination involves detecting 5-HIES in a 24-hour urine sample (a breakdown product of serotonin released by tumors). If nothing is found, further examinations may be unnecessary. If elevated levels are detected, the tumor is sought through an endoscopy and colonoscopy.
In summary, if you are experiencing isolated flushing only in relation to alcohol, without other symptoms and with periods of non-reaction, alcohol is likely the trigger, and a carcinoid is very unlikely given your age. These flushing phenomena are about 400-800% more common in the population than carcinoids.
I hope this information helps.
PS: Your primary care physician can also perform the initial examination of the 5-HIES breakdown products in your urine. This will give you quick clarity and allow you to live more relaxed.
With warm regards,
Dr. R. C. Berg
