CHD2021 Second International Symposium on Carcinoid Heart Disease 2021 Abstracts (5 abstracts)
Nutritional recovery is essential for successful management of patients with advanced carcinoid heart disease
Husnain Shah , Reena Mair , Sayqa Arif , Stacey Smith , Suzanne Vickrage , Joanne Kemp-Blake , Samuel Denham , Tessa Oelofse , Harjot Singh , Stephen Rooney , Richard Steeds & Tahir Shah
Queen Elizabeth Hospital Birmingham NHS Foundation Trust
Introduction Chronic heart failure is a catabolic state leading to cachexia in 5-15% of patients, predicting poor survival outcomes. Malnutrition affects 40% of patients with NETs and 58% with carcinoid syndrome (CS).
Case 45M with severe carcinoid heart disease, on referral and admission was cachectic with BMI of 16, having lost 32 kg or 30% of body weight, meeting 50% of dietary requirements and at risk of refeeding syndrome. Nasogastric feeding (NG) was started with 1L Nutrison energy Multifibre. Six days later he was also managing all 3 meals, snacks, snack box, and cooked breakfast daily. Fortisip compact protein BD provided additional 600kcal and 36g protein. Steatorrhea occurred due to octreotide. Creon 25,000U 2-3 with meals and 1-2 with snacks/ ONS prescribed, titrated up 27/3/2019 for persistent steatorrhea. Nutritional requirements were calculated based on 52 kg weight at 1820kcal (35kcal/kg) + 65g protein (0.2g of nitrogen). NG feed changed to peptide based peptisorb 1.8L providing 1800kcal and 72g protein daily from feed alone. Urinary 5HIAA was 1189 on admission; suffering with severe CS and mini carcinoid crises on standing despite receiving sandostatin LAR 30mg 4 weekly. Considerably short of breath at rest, NYHA class 4 with orthopnoea and PND. CS was managed with increase in sandostatin 30mg frequency to 2 weekly, addition of octreotide 100mcg s/c tds and telotristat 250mg p.o. tds. 5hiaa improved to 429 before cardiac interventions. Weight plateaued by the 19/4/2019; NG feed was increased. 12/6/2019 he weighed 67.4 kg BMI-22 kg/m
Outcomes 24/07/2019 NGT out. He continued with fortisip compact protein TDS as an additional top up providing a further 900kcal and 54g protein. Weight 74.1 kg at discharge and reported visually stable over following 8 months. 5HIAA 35 (normal) at discharge. From mid-admission 02/05/19 to discharge on 7/8/2019: Minnesota living with heart failure score improved from 83 to 19; EORTC QLQC30 from 88 to 56 and GINET21 from 50 to 34.
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Endocrine Abstracts
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