Diagnosis and Treatment of Malignant Carcinoid Syndrome

To the Editor.— The article, "Diagnosis and Treatment of Malignant Carcinoid Syndrome," by Dr. A. L. Ureles (229:1346, 1974) contains several serious errors. In this letter I shall concentrate on those that have substantial patient-care implications. Documentation of the statements I shall make may be found in a recent textbook chapter1that will also provide access to the primary literature from which they are derived. I shall restrain myself from taking issue with the several incorrect statements that are likely to be more of interest to professional pedants than to practicing physicians who wish to understand how to safely and effectively diagnose and treat the carcinoid syndrome. The dose of epinephrine that Dr. Ureles designates for intravenous administration to perform the epinephrine provocative test is 5 mg. He concludes: "Reports of severe vascular collapse and paradoxical hypertension would suggest, however, thatpressor amines should be avoided in the evaluation