Carcinoid Syndrome in a Patient with Duodenal Carcinoid Tumor

Khan Mohammad Nazmus Saqeb,Fariah Sharmeen,Farzana Hafiz

doi:10.11648/j.crj.20210903.15

Abstract

Duodenal carcinoid tumors accounts for 5% of all Gastrointestinal Neuroendocrine Tumors (GI-NETs). Only 4% of all duodenal carcinoid tumors present with a full-blown carcinoid syndrome. We report a case of duodenal carcinoid tumor presenting as carcinoid syndrome in a 58 year old man, who presented with upper abdominal discomfort, diarrhoea, hot flushes and occasional wheezing. Histopathology following endoscopic resection of the tumor and 24 hour urinary 5-Hydroxyindolacetic acid (5-HIAA) confirmed the diagnosis. Duodenal carcinoid tumors are one of the rarest tumors of gastrointestinal tract and their association with a typical carcinoid syndrome is not that common. A high level of suspicion is required for an early diagnosis. With proper resection (endoscopic or surgical) of a localized tumor, recurrence and progression of the disease can be halted. Symptoms of carcinoid syndrome should be controlled by antidiarrheal agents, inhaled β-adrenergic agonist bronchodilators and somatostatin analogs (octreotide, lanreotide). Patients should be advised to avoid stress and conditions or substances that precipitate these symptoms. Dietary supplementation with nicotinamide can help in this regard. Patients with hepatic metastases are treated with synthetic analogues of somatostatin (octreotide, lanreotide). Systemic chemotherapy is not recommended in metastatic disease by the current guidelines. Patients should be followed up by monitoring serum chromogranin and urinary 5-HIAA. EUS, CT, MRI & somatostatin receptor scintigraphy can also be used for following up the patients.

Highlights

IntroductionGastrointestinal Neuroendocrine Tumors (GI-NETs) (carcinoid) comprise nearly 70% of all carcinoid tumors. GI carcinoids most commonly occur in the small intestine, rectum, appendix, or stomach
Gastrointestinal Neuroendocrine Tumors (GI-NETs) comprise nearly 70% of all carcinoid tumors
Various GI hormones are frequently found in duodenal carcinoids, no clinical syndrome is seen in 58% to 98% of patients

Summary

Introduction

GI-NETs (carcinoid) comprise nearly 70% of all carcinoid tumors. GI carcinoids most commonly occur in the small intestine, rectum, appendix, or stomach. Duodenal carcinoids comprise 22% of all small intestinal carcinoids, mostly arising from the first and second part of duodenum. A 58 year old nondiabetic normotensive man presented with the complaints of upper abdominal discomfort for 6 months, passage of loose watery stool for 3 months and recurrent hot flushes involving face and neck for the same duration He complained of occasional wheezing, which he has noticed for last few months and is precipitated by doing exercise. Contrast enhanced CT scan of whole abdomen revealed no evidence of regional lymphadenopathy or hepatic metastases. The mass was sent for histopathology after endoscopic resection, which revealed a duodenal carcinoid tumor. The patient experienced a gradual reduction of symptoms after endoscopic resection He is absolutely asymptomatic after 6 months of resection with no evidence of recurrence or distant metastases. Contrast enhanced CT scan of whole abdomen revealed a polypoid intraluminal mass about 1.5 cm in

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Discussion

Conclusion