Carcinoid Syndrome in a Patient with Duodenal Carcinoid Tumor

Khan Mohammad Nazmus Saqeb; Fariah Sharmeen; Farzana Hafiz

doi:doi:10.11648/j.crj.20210903.15

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Carcinoid Syndrome in a Patient with Duodenal Carcinoid Tumor

Khan Mohammad Nazmus Saqeb, Fariah Sharmeen, Farzana Hafiz

Published in Cancer Research Journal (Volume 9, Issue 3)

Received: 10 July 2021 Accepted: 27 July 2021 Published: 4 August 2021

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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.

Published in	Cancer Research Journal (Volume 9, Issue 3)
DOI	10.11648/j.crj.20210903.15
Page(s)	162-165
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Carcinoid Syndrome, Duodenal Carcinoid, Gastrointestinal Neuroendocrine Tumors (GI-NETs)

References

[1]	Soga J. Endocrinocarcinomas (carcinoids and their variants) of the duodenum. An evaluation of 927 cases. J Exp Clin Cancer Res 2003; 22: 349-63.
[2]	Burke AP, Sobin LH, Federspiel BH, et al. Carcinoid tumors of the duodenum. A clinicopathologic study of 99 cases. Arch Pathol Lab Med 1990; 114: 700-4.
[3]	Strosberg JR & Al-Toubah T. Neuroendocrine Tumors. In: Feldman M, Friedman LS and Brandt LJ, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. Elsevier: Philadelphia; 2021: 472-497.
[4]	Jensen RT, Doherty GM. Carcinoid tumors and the carcinoid syndrome. In: DeVita VT Jr, Hellman S, Rosenberg SA, editors. Cancer: Principles and practice of oncology. 7th ed. Philadelphia: Lippincott Williams and Wilkins; 2005: 1559-74.
[5]	Jensen RT. Overview of chronic diarrhea caused by functional neuroendocrine neoplasms. Semin Gastrointest Dis 1999; 10: 156-72.
[6]	Gustafsson BI, Hauso O, Drozdov I, et al. Carcinoid heart disease. Int J Cardiol 2008; 129: 318-24.
[7]	Lips CJ, Lentjes EG, Hoppener JW. The spectrum of carcinoid tumours and carcinoid syndromes. Ann Clin Biochem 2003; 40: 612-27.
[8]	Nuttall KL, Pingree SS. The incidence of elevations in urine 5-hydroxyindoleacetic acid. Ann Clin Lab Sci 1998; 28: 167-74.
[9]	Feldman JM. Serotonin metabolism in patients with carcinoid tumors: Incidence of 5-hydroxytryptophansecreting tumors. Gastroenterology 1978; 75: 1109-14.
[10]	Hoffmann KM, Furukawa M, Jensen RT. Duodenal neuroendocrine tumors: Classification, functional syndromes, diagnosis and medical treatment. Best Pract Res Clin Gastroenterol 2005; 19: 675-97.
[11]	Delle Fave G, Kwekkeboom DJ, Van Cutsem E, et al. ENETS consensus guidelines for the management of patients with gastroduodenal neoplasms. Neuroendocrinology 2012; 95: 74-87.
[12]	Oberg K, Kvols L, Caplin M, et al. Consensus report on the use of somatostatin analogs for the management of neuroendocrine tumors of the gastroenteropancreatic system. Ann Oncol 2004; 15: 966-73.
[13]	Naalla R, Konchada K, Kannappan O, et al. BMJ Case Rep Published online: 2014. doi: 10.1136/bcr-2013-202159.
[14]	Pavel M, Baudin E, Couvelard A, et al. ENETS Consensus Guidelines for the management of patients with liver and other distant metastases from neuroendocrine neoplasms of foregut, midgut, hindgut, and unknown primary. Neuroendocrinology 2012; 95: 157–76.

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Khan Mohammad Nazmus Saqeb, Fariah Sharmeen, Farzana Hafiz. (2021). Carcinoid Syndrome in a Patient with Duodenal Carcinoid Tumor. Cancer Research Journal, 9(3), 162-165. https://doi.org/10.11648/j.crj.20210903.15

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ACS Style

Khan Mohammad Nazmus Saqeb; Fariah Sharmeen; Farzana Hafiz. Carcinoid Syndrome in a Patient with Duodenal Carcinoid Tumor. Cancer Res. J. 2021, 9(3), 162-165. doi: 10.11648/j.crj.20210903.15

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AMA Style

Khan Mohammad Nazmus Saqeb, Fariah Sharmeen, Farzana Hafiz. Carcinoid Syndrome in a Patient with Duodenal Carcinoid Tumor. Cancer Res J. 2021;9(3):162-165. doi: 10.11648/j.crj.20210903.15

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@article{10.11648/j.crj.20210903.15,
  author = {Khan Mohammad Nazmus Saqeb and Fariah Sharmeen and Farzana Hafiz},
  title = {Carcinoid Syndrome in a Patient with Duodenal Carcinoid Tumor},
  journal = {Cancer Research Journal},
  volume = {9},
  number = {3},
  pages = {162-165},
  doi = {10.11648/j.crj.20210903.15},
  url = {https://doi.org/10.11648/j.crj.20210903.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/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.},
 year = {2021}
}

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TY - JOUR
T1 - Carcinoid Syndrome in a Patient with Duodenal Carcinoid Tumor
AU - Khan Mohammad Nazmus Saqeb
AU - Fariah Sharmeen
AU - Farzana Hafiz
Y1 - 2021/08/04
PY - 2021
N1 - https://doi.org/10.11648/j.crj.20210903.15
DO - 10.11648/j.crj.20210903.15
T2 - Cancer Research Journal
JF - Cancer Research Journal
JO - Cancer Research Journal
SP - 162
EP - 165
PB - Science Publishing Group
SN - 2330-8214
UR - https://doi.org/10.11648/j.crj.20210903.15
AB - 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.
VL - 9
IS - 3
ER -

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Author Information

Khan Mohammad Nazmus Saqeb

Department of Gastrointestinal, Hepatobiliary & Pancreatic Diseases, Jahurul Islam Medical College & Hospital, Kishoreganj, Bangladesh
Fariah Sharmeen

Department of Oncology, Square Hospitals Ltd., Dhaka, Bangladesh
Farzana Hafiz

Department of Pathology, Square Hospitals Ltd., Dhaka, Bangladesh

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Plain Text BibTeX RIS

APA Style

Khan Mohammad Nazmus Saqeb, Fariah Sharmeen, Farzana Hafiz. (2021). Carcinoid Syndrome in a Patient with Duodenal Carcinoid Tumor. Cancer Research Journal, 9(3), 162-165. https://doi.org/10.11648/j.crj.20210903.15

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ACS Style

Khan Mohammad Nazmus Saqeb; Fariah Sharmeen; Farzana Hafiz. Carcinoid Syndrome in a Patient with Duodenal Carcinoid Tumor. Cancer Res. J. 2021, 9(3), 162-165. doi: 10.11648/j.crj.20210903.15

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AMA Style

Khan Mohammad Nazmus Saqeb, Fariah Sharmeen, Farzana Hafiz. Carcinoid Syndrome in a Patient with Duodenal Carcinoid Tumor. Cancer Res J. 2021;9(3):162-165. doi: 10.11648/j.crj.20210903.15

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@article{10.11648/j.crj.20210903.15,
  author = {Khan Mohammad Nazmus Saqeb and Fariah Sharmeen and Farzana Hafiz},
  title = {Carcinoid Syndrome in a Patient with Duodenal Carcinoid Tumor},
  journal = {Cancer Research Journal},
  volume = {9},
  number = {3},
  pages = {162-165},
  doi = {10.11648/j.crj.20210903.15},
  url = {https://doi.org/10.11648/j.crj.20210903.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/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.},
 year = {2021}
}

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