Approximately 5% of all patients with carcinoid tumors experience 1 or more symptoms of the carcinoid syndrome, including flushing, diarrhea, and valvular heart disease. Especially early in the course, symptoms are usually episodic. We report a case of carcinoid syndrome accompanied by chronic diarrhea.
The patient is a 60-year-old Hispanic woman who presented with a history of diarrhea for 11 years. The diarrhea was described as frequent (30-40 times per day), explosive, and watery, without blood or mucus. The patient had no flushing, abdominal pain, weight loss, or history of travel. She had received medical attention several times, and was treated symptomatically with antidiarrheal agents without significant relief. She had no allergies. Her medical history was significant for well-controlled hypertension and type 2 diabetes mellitus. Her surgical history was significant for cholecystectomy, appendectomy, and total abdominal hysterectomy. Medications included metformin, captopril, and glyburide. Her social history was unremarkable, with no history of tobacco, ethanol, or drug use. Her family history was unremarkable, and her vital signs were normal. Remarkable findings on physical examination included a holosystolic murmur loudest at the left lower sternal border that increased in intensity with inspiration, bilateral ankle edema (1+), and a Hemoccult-negative stool examination result. The results of a laboratory examination, including a complete blood cell count, a comprehensive metabolic panel, prothrombin time, partial thromboplastin time, and urinalysis, were unremarkable. Findings from the chest x-ray film and electrocardiogram were normal. Stool examination revealed no ova, parasites, or fat, and stool cultures were unremarkable. Further evaluation with 2-dimensional echocardiography revealed moderate tricuspid regurgitation (Figure 1), a moderately elevated estimated pulmonary artery systolic pressure, and multiple small echolucent lesions in the liver. Abdominal computed tomography revealed multiple hypodense lesions in the liver (Figure 2). A percutaneous needle biopsy of the liver lesions was performed. The pathological features were consistent with a carcinoid tumor. Blood serotonin concentration was 1720 ng/mL (normal, 20-200 ng/mL). Subsequent indium In 111 octreotide imaging revealed the primary tumor to be in the ileum. The patient underwent surgical resection and was treated with somatostatin. The patient's symptoms have completely resolved, and she has 2 to 3 well-formed stools daily.
Jothi SP, Miller S. Gastrointestinal Carcinoid Tumor in a Patient With Chronic Diarrhea. Arch Intern Med. 2002;162(1):95–96. doi: