Chronic diarrhea, weight loss and heart failure. Features of the same disease?

Diarrea crónica, síndrome constitucional e insuficiencia cardiaca. ¿Manifestaciones de una misma entidad?

Key words: Tumor. Carcinoid. Metastasis.

Palabras clave: Tumor. Carcinoide. Metástasis.

Dear Editor,

A 78 year old man presented with a history of chronic diarrhea, weight loss and shortness of breath. The physical examination revealed a red facial flush, hepatomegaly and a systolic heart murmur. Multiple liver lesions were found on abdominal ultrasound. The abdominal computed tomography (CT) showed evidence of liver metastases and a tumor in the ileum with lymph node infiltration (Fig. 1). A fine needle puncture aspiration of the liver was performed and was compatible with a carcinoid tumor. The octreoscan showed areas of uptake in the liver and ileum. The echocardiography indicated carcinoid-related tricuspid valve disease with severe tricuspid regurgitation that required early surgical treatment. The patient was treated symptomatically with somatostatin analogs with a good response.

Discussion

Carcinoid tumors are mainly located in the small bowel (1). They can be asymptomatic or produce symptoms due to tumor bulk such as intestinal obstruction or bleeding. In addition, they can produce the carcinoid syndrome. This includes red facial flush, diarrhea, wheezing and valvular heart disease. This is unusual and is associated with increased morbidity and mortality, requiring an early surgical intervention (2).

In those patients with clinical suspicion of carcinoid syndrome, the measurement of urinary 5-HIAA levels is used to confirm the diagnosis (3). Imaging tests such as the octreoscan, magnetic resonance imaging (MRI) or CT scan with oral contrast are required for localization of both primary lesions and metastasis (4).

Somatostatin-analogue therapies such as the octreotide are given for symptomatic relief. Surgical resection of the tumor is the only curative therapy and must be performed if there is no evidence of metastatic disease.

References

1. Rorstad O. Prognostic indicators for carcinoid neuroendocrine tumors of the gastrointestinal tract. J Surg Oncol 2005;89:15. DOI: 10.1002/jso.20179.         [ Links ]

2. Roberts WC. A unique heart disease associated with a unique cancer: Carcinoid heart disease. Am J Cardiol 1997;80:25. DOI: 10.1016/S0002-9149(97)00340-8.         [ Links ]

3. Zandee W, Kamp K, Van Adrichem RC, et al. Limited value for urinary 5-HIAA excretion as prognostic marker in gastrointestinal neuroendocrine tumors. Eur J Endocrinol 2016. DOI: 10.1530/EJE-16-0392.         [ Links ]

4. Sadowski SM, Neychev V, Millo C, et al. Prospective Study of 68Ga-DOTATATE positron emission tomography/computed tomography for detecting gastro-entero-pancreatic neuroendocrine tumors and unknown primary sites. J Clin Oncol 2016;34(6):588-96. DOI: 10.1200/JCO.2015.64.0987.         [ Links ]