Endocrine Abstracts

Carcinoid cardiac disease is a rare cause of intrinsic right heart valve disease with significant impact on mortality. We present the case of a young male patient (38 yrs old) complaining in the last 5 yrs of abdominal pain associated with flushing of the face that progressively worsened (up to 15 episodes/day) accompanied by diarrhoea and, in the last 2 months, by night sweats, distension of the abdomen, bilateral ankle swelling and progressive limitation in effort. Endocrine evaluation revealed high levels of serum markers for neuroendocrine tumor (NET) and multiple large liver metastases on the CT scan of the abdomen, confirmed on Octreoscan but with no identifiable primary. Biopsy of liver metastasis diagnosed a Grade 2 NET -Ki67 4%, and was suggestive for secondary determination from a small bowel NET. Due to the discovery of important ascites, echocardiography was performed and revealed important tricuspid and pulmonary regurgitations, severe right heart failure and very high level of pro-BNP (8Xupper limit). Somatostatin analogue treatment was started with significant improvement in symptoms and NET markers, thus allowing cardiac surgery with remission of symptoms related to heart failure, giving us time for search of the primary and deciding the adequate treatment for the NET.