Hospital visiting guidelines updated 20 July 2022: Hospital visitors must wear a surgical/medical paper mask. Fabric face coverings are no longer acceptable. See our COVID-19 pages for detailed information about hospital visiting guidelines, COVID-19 tests and care in the community advice. See www.vaccinatecanterburywestcoast.nz for information about vaccinations.
We are at ORANGE according to the NZ COVID-19 Protection Framework
Last updated:
9th April 2022
Kia whakahaumaru te whānau, me ngā iwi katoa – this is to keep everybody safe:
By sticking to the rules above, you help keep our patients, staff, other visitors and yourself safe. We thank you in advance for your patience and understanding as our staff work hard to protect and care for some of the most vulnerable in our community.
Exceptions to the ‘one visitor’ policy
Visiting patients with COVID-19
You must NOT visit the hospital if you
Exceptions for people with disabilities
An exception will be made for people with disabilities who are in hospital or have to attend an outpatient appointment – where they need a support person to access health services. For example, a sign language interpreter, support person for someone with a learning disability, or someone to assist with mobility. The support person is in addition to the one permitted visitor.
Everyone visiting our facilities must wear a mask, no exceptions
While we appreciate that some people have legitimate reasons for being exempt from wearing a mask and may even have an official card to confirm this, people who cannot or will not wear a mask cannot visit someone in hospital or attend hospital, other than to access healthcare. This is another measure to minimise the risk to vulnerable patients.
Patients and visitors should also read the additional more detailed visiting guidelines for each specific hospital.
More COVID-19 information
Lipids/Trace Metals
SERO
5-hydroxytryptamine
5HT
4 weeks
3468
5
1
3
Frozen
If overnight - Frozen
The Diagnosis of Carcinoid Syndrome©
Definition
Carcinoid tumours are neuroendocrine tumours that usually arise from enterochromaffin cells, which are found scattered throughout the body but occur principally in the submucosa of the intestine and main bronchi. The carcinoid syndrome is caused by systemic release of one or more of the secretory products: amines, polypeptides, and or prostaglandins.
Clinical presentation
The most common manifestations of carcinoid syndrome are vasomotor changes (flushing), gastrointestinal hypermotility (diarrhoea), bronchospasm (wheezing, dyspnoea) and hypotension.
An attack of carcinoid syndrome may be provoked by emotional stress, heat, ingestion of particular foods or alcohol, straining at stool, or exogenous stimulation with adrenaline, dopamine or gastrin.
Carcinoid crisis with severe flushing and diarrhoea leading to dehydration, hypotension, and arrhythmias, along with unconsciousness, is a potentially life threatening complication.
Tumour markers
Urinary 5 hydroxyindolacetic acid (5-HIAA), the breakdown product of serotonin, has been the gold standard for diagnosis and follow-up, of the carcinoid syndrome, for many years. The specificity of urinary 5-HIAA is almost 100%, if appropriate dietary restrictions are observed, but the sensitivity is reported to be much lower (35%). Urinary 5-HIAA levels can be influenced by food (e.g. bananas, avocados, pineapple, walnuts, tomatoes, plums and kiwifruit) consumption and some medications.
Whole blood (platelet) serotonin levels are a more sensitive marker for the detection of small amounts of serotonin. However, in cases with a high rate of serotonin excretion, serotonin in platelets reaches a maximum, limiting its use during follow-up. Elevated serotonin concentrations may also be found in paragangliomas and thrombocytopania.
Chromogranin A (CgA), in contrast to urinary 5-HIAA and platelet serotonin, can be used in the detection of functioning as well as non-functioning carcinoid tumours. Elevated CgA concentrations are not specific for neuroendocrine tumours and may also be seen in renal impairment, liver failure, inflammatory bowel disease and prostatic carcinoma. Thus its specificity is lower than urinary 5-HIAA (86%) but its sensitivity is higher (68%). Levels of CgA are correlated with tumour burden, and very high levels have been suggested to indicate a significantly worse survival rate.
Midgut carcinoid tumours produce the enzyme decarboxylase which transforms 5-hydroxytryptophan (5-HTP) into serotonin. Therefore serotonin and 5-HIAA levels maybe significantly raised. However, in carcinoid tumours of the foregut, the absence of this decarboxylase results in more modest increases of serotonin and 5-HIAA, as only partial conversion (by the kidney) of 5-HTP to serotonin occurs. In end-gut carcinoids, both the hydroxylase and decarboxylase may be absent and no 5-HTP, serotonin or 5-HIAA is produced.
In contrast CgA levels are independent of tumour location and can be used as a marker of for-, mid- and end-gut carcinoids.
To diagnosis presenting symptoms of carcinoid syndrome, 24 hour urinary 5-HIAA is recommended (with dietary restrictions). Blood CgA and serotonin levels are useful for monitoring the treatment of established disease and may also be use when 5-HIAA levels are equivocal. CgA levels may be used to establish tumour burden.
References
Lips CJM, Lentjes EGWM, Hoppener JWM. The spectrum of carcinoid tumours and carcinoid syndromes. Ann Clin Biochem (review) 2003;40:612-627.
Zuetenhorst JM,Tall BG. Metastatic Carcinoid Tumors: A Clinical Review. Oncologist (review) 2005;10(2):123-31.
Modlin IM, Kidd MM, Latich I et al. Current status of gastrointestinal carcinoids. Gastroenterology 2005;128:1717-1751.
Adult 0.4 – 1.5 umol/L
Children 0.8 – 2.0 umol/L
Solvent extraction, fluorescence
$238.04 (Exclusive of GST)
3468
Serum or plasma are unacceptable sample types.