Endocrine Abstracts

Aim of the audit: Guidelines recommend screening for carcinoid heart disease (CaHD) in patients with carcinoid syndrome (CS) using 5-hydroxyindoleacetic acid (5HIAA), NT-pro BNP and Echocardiogram. We audited patients with CS for these parameters and gathered information related to social deprivation.

Objectives: To ensure that the CS diagnosis was confirmed biochemically, assessment of social deprivation, review of waiting times, audit of echocardiogram requests when 24-hour urinary 5-HIAA >300 μmol/l.

Methodology: The Sheffield NET database was interrogated retrospectively to review patients with and without CaHD who had been referred to neuroendocrine MDT. Data was collected for 50 patients.

Results: 62% of patients were females, mean age 65 years. 96% had < 2 weeks waiting period between referral and MDT discussion. 90% had 24-hour urine 5HIAA to confirm the diagnosis biochemically. Assessment of NT-Pro BNP was low at 20%. 50% of patients were found to have severe CS with 24-hour U5HIAA > 300 μmol, of whom 92% had echocardiography performed. 34 out of 49 patients with CS were in the 1 – 6 most deprived areas as per the index of multiple deprivation deciles ranking in comparison to 14 out of the 17 patients who had both CS and CHD.

Conclusion: Sheffield NET Centre has a short waiting time from referral to MDT review for CS patients, appropriate biochemical and echocardiography were requested. Improvements in NT pro-BNP requesting could be made. Here we highlight 82 % of the patients with severe CS and CaHD live in the most socially deprived areas. These findings might be helpful to facilitate strategies to aid early diagnosis and management of patients with CS/CaHD where it is needed most. To our knowledge this is the first association of deprivation and CaHD. Further national study could lead to improvement in morbidity and mortality.